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General NPI Number Information
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NPI Number | 1982510517
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Entity Type | Organization
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Legal Business Name | LATITUDE 41 MEDICAL PLLC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 27 N MAIN ST UNIT 7A
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City | KENT
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State | CT
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Zip | 06757-1551
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Country | US
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Telephone | 312-890-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 27 N MAIN ST UNIT 7A
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City | KENT
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State | CT
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Zip | 06757-1551
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Country | US
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Telephone | 312-890-9331
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Fax |
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Authorized Official
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Title or Position | APRN PROVIDER / OWNER
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Name | MICHELLE TOLBERT
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Credential | APRN FNP BC
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Telephone | 312-890-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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