Provider Demographics
NPI:1376812115
Name:CONNER, LATRICA (NP)
Entity Type:Individual
Prefix:MS
First Name:LATRICA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 EASTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1639
Mailing Address - Country:US
Mailing Address - Phone:917-334-5546
Mailing Address - Fax:
Practice Address - Street 1:3535 QUAKERBRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1200
Practice Address - Country:US
Practice Address - Phone:609-249-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01395700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health