MEDICARE: CHELSEA BETH LATOURETTE CRNP

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	363LF0000X	Family Nurse Practitioner	SP021680	PA

General Provider Information

NPI Number	:	1346876521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA BETH LATOURETTE CRNP

Provider Business Mailing Address
First Line	:	273 GRANDVIEW AVE STE 4
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1163
Country	:	US
Telephone Number	:	570-390-4545
Fax Number	:	570-390-4546

Provider Business Practice Location Address
First Line	:	273 GRANDVIEW AVE STE 4
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1163
Country	:	US
Telephone Number	:	570-390-4545
Fax Number	:	570-390-4546

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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