Provider Demographics
NPI:1497727135
Name:LATIMER, NANCY (RN, NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LATIMER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N DUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4663
Mailing Address - Country:US
Mailing Address - Phone:707-546-9400
Mailing Address - Fax:707-546-9464
Practice Address - Street 1:1255 N DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4663
Practice Address - Country:US
Practice Address - Phone:707-546-9400
Practice Address - Fax:707-546-9464
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily