Doctor Name: | KAYLA LATZ |
NPI Number: | 1467853523 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | |
Business Practice Address: | 11108 Parkview Circle Dr Suite 5100 Fort Wayne, IN - 468451730 |
Business Phone Number: | 2602662800 |
Business Fax Number: | 2602662805 |
Mailing Address: | 1234 E Dupont Rd, Suite 3 FORT WAYNE |
State: | IN |
Postal Code: | 468251545 |
Phone Number: | 2603739700 |
Fax Number: | 2603739740 |
NPI Enumeration Date: | 09/09/2014 |
NPI Last Update Date: | 09/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |