MEDICARE: LORETTA LATSNIC CNP

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	363LA2200X	Adult Health Nurse Practitioner	COA 16287 -NP	OH

General Provider Information

NPI Number	:	1083021224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA LATSNIC CNP

Provider Business Mailing Address
First Line	:	2352 COLUMBIA RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-4103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24701 EUCLID AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:	440-829-2249
Fax Number	:

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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