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General NPI Number Information
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NPI Number | 1962265199
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Entity Type | Individual
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Provider Name | CRAIG LARRY LATHEN FNP
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Gender | Male
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1623 HOSPITAL LOOP
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City | OWYHEE
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State | NV
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Zip | 89832-1200
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Country | US
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Telephone | 775-757-2415
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Fax | 775-757-3010
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Provider Business Mailing Address
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Address Line | PO BOX 116
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City | MOUNTAIN CITY
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State | NV
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Zip | 89831-0116
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Country | US
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Telephone | 208-851-2472
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 55861
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License Number State | ID
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