Provider Demographics
NPI:1073509832
Name:LATSHA, MICHELLE L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:LATSHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WILSON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3650
Mailing Address - Country:US
Mailing Address - Phone:717-249-1929
Mailing Address - Fax:717-249-9332
Practice Address - Street 1:220 WILSON ST STE 109
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3697
Practice Address - Country:US
Practice Address - Phone:717-249-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP57182Medicare UPIN