Provider Demographics
NPI:1295041994
Name:LATTEN, JUDY LYNN (STNA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:LATTEN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13408 EMILY ST
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4561
Mailing Address - Country:US
Mailing Address - Phone:216-240-1365
Mailing Address - Fax:
Practice Address - Street 1:13408 EMILY ST
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4561
Practice Address - Country:US
Practice Address - Phone:216-240-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide