1518304906 NPI number — MRS. LAVONE RENITA LATTIMORE LMT

Table of content: MRS. LAVONE RENITA LATTIMORE LMT (NPI 1518304906)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518304906 NPI number — MRS. LAVONE RENITA LATTIMORE LMT

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
LATTIMORE

Provider First Name:
LAVONE

Provider Middle Name:
RENITA

Provider Name Prefix Text:
MRS.

Provider Name Suffix Text:

Provider Credential Text:
LMT

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
JONES-LATTIMORE

Provider Other First Name:
LAVONE

Provider Other Middle Name:
RENITA

Provider Other Name Prefix Text:
MRS.

Provider Other Name Suffix Text:

Provider Other Credential Text:
LPN

Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518304906

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
05/27/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5702 CENTER DR

Provider Second Line Business Mailing Address:
N/A

Provider Business Mailing Address City Name:
TEMPLE HILLS

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20748-2302

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
301-906-7168

Provider Business Mailing Address Fax Number:
301-420-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5702 CENTER DR

Provider Second Line Business Practice Location Address:
N/A

Provider Business Practice Location Address City Name:
TEMPLE HILLS

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20748-2302

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-906-7168

Provider Business Practice Location Address Fax Number:
301-420-3480

Provider Enumeration Date:
05/27/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 174400000X , with the licence number: M02482 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 208100000X , with the licence number: M02482 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .