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NPI Code Detail

MEDICARE: DR. JENNIFER HOLMES LATTERELL DO

MEDICARE: DR. JENNIFER HOLMES LATTERELL DO
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
1207Q00000XFamily Medicine Physician18509MN
2207Q00000XFamily Medicine Physician49315MN
3207Q00000XFamily Medicine Physician4510IA

General Provider Information

NPI Number : 1902925365
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER HOLMES LATTERELL DO
Provider Business Mailing Address
First Line : 1026 A AVE NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5036
Country : US
Telephone Number : 319-369-7393
Fax Number : 319-369-8351
Provider Business Practice Location Address
First Line : 1201 3RD AVE SE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52403-4009
Country : US
Telephone Number : 319-730-7300
Fax Number : 319-739-7368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 10/29/2013

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