Provider Demographics
NPI:1346876521
Name:LATOURETTE, CHELSEA BETH (CRNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BETH
Last Name:LATOURETTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 GRANDVIEW AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1163
Mailing Address - Country:US
Mailing Address - Phone:570-390-4545
Mailing Address - Fax:570-390-4546
Practice Address - Street 1:273 GRANDVIEW AVE STE 4
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1163
Practice Address - Country:US
Practice Address - Phone:570-390-4545
Practice Address - Fax:570-390-4546
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily