Provider Demographics
NPI:1336100338
Name:LATIMORE, ADINE (RN,MSN,PNP,SANE)
Entity Type:Individual
Prefix:MRS
First Name:ADINE
Middle Name:
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:RN,MSN,PNP,SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 FORDWAY EXT
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4367
Mailing Address - Country:US
Mailing Address - Phone:603-264-7222
Mailing Address - Fax:617-779-2132
Practice Address - Street 1:989 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1308
Practice Address - Country:US
Practice Address - Phone:617-779-2144
Practice Address - Fax:617-779-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181164363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics