Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN273568 | MA |
NPI | 1003113291 |
---|---|
Provider Name | Christine Nichole Lattuada |
First Address | Brockton, MA 02301-2864 |
Second Address | Brockton, MA 02301-2864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2011 |
Last Update Date | 24/02/2011 |