Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 33980 | IA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 33980 | IA |
NPI | 1639170103 |
---|---|
Provider Name | Deborah Lathrop |
First Address | Cresco, IA 52136-1062 |
Second Address | Cresco, IA 52136-1062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 04/01/2016 |