MEDICARE: MS. MICHELLE L. LATSHA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA050704	PA

General Provider Information

NPI Number	:	1073509832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE L. LATSHA PA-C

Provider Business Mailing Address
First Line	:	220 WILSON ST STE 109
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3650
Country	:	US
Telephone Number	:	717-249-1929
Fax Number	:	717-249-9332

Provider Business Practice Location Address
First Line	:	220 WILSON ST STE 109
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3697
Country	:	US
Telephone Number	:	717-249-1929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/29/2020

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