Provider Demographics
NPI:1093222994
Name:LATVA, DONNA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:LATVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 TIBBETTS WICK RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1138
Mailing Address - Country:US
Mailing Address - Phone:330-306-9651
Mailing Address - Fax:
Practice Address - Street 1:103 COTTON CREEK RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-7954
Practice Address - Country:US
Practice Address - Phone:910-428-9020
Practice Address - Fax:910-428-9022
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily