MEDICARE: MARYAM H LATEEF MHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP 1782	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477533610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM H LATEEF MHNP

Provider Business Mailing Address
First Line	:	7219 S 15TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6930
Country	:	US
Telephone Number	:	602-403-5050
Fax Number	:	623-777-0820

Provider Business Practice Location Address
First Line	:	8613 S 7TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-8311
Country	:	US
Telephone Number	:	480-835-2371
Fax Number	:	623-847-4047

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	12/19/2019

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