Doctor Name: | STACEY ERIN LATTANZE |
NPI Number: | 1629116728 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA002230-L |
Business Practice Address: | 14 Philadelphia Ave Shillington, PA - 196072757 |
Business Phone Number: | 6107777781 |
Business Fax Number: | 6107771275 |
Mailing Address: | 476 State Route 897 E, NEWMANSTOWN |
State: | PA |
Postal Code: | 170738718 |
Phone Number: | 7179498006 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA002230-L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |