MEDICARE: LOIS EILEEN LATTIMORE NP

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	308	AZ

General Provider Information

NPI Number	:	1932171386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS EILEEN LATTIMORE NP

Provider Business Mailing Address
First Line	:	1891 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-742-4183
Fax Number	:	520-742-4110

Provider Business Practice Location Address
First Line	:	1891 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-742-4183
Fax Number	:	520-742-4110

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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