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General NPI Number Information
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NPI Number | 1912013954
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Entity Type | Individual
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Provider Name | SWARNA ERRAMREDDI LATHA M.D
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 675 WATER ST
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City | EXCELSIOR
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State | MN
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Zip | 55331-3063
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Country | US
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Telephone | 952-474-4167
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Fax | 952-474-5700
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Provider Business Mailing Address
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Address Line | 1852 N MASTICK WAY
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City | NOGALES
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State | AZ
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Zip | 85621-1063
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Country | US
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Telephone | 520-761-2128
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Fax | 520-281-1112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36343
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License Number State | MN
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