Provider Demographics
NPI:1609209212
Name:LATTIMORE, CELIA (RN)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 SLAB LANDING RD.
Mailing Address - Street 2:
Mailing Address - City:COPE
Mailing Address - State:SC
Mailing Address - Zip Code:29038
Mailing Address - Country:US
Mailing Address - Phone:803-534-8081
Mailing Address - Fax:803-531-5614
Practice Address - Street 1:6030 SLAB LANDING RD.
Practice Address - Street 2:
Practice Address - City:COPE
Practice Address - State:SC
Practice Address - Zip Code:29038
Practice Address - Country:US
Practice Address - Phone:803-534-8081
Practice Address - Fax:803-531-5614
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24729163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool