Provider Demographics
NPI:1689915506
Name:LATIMER, LATRINDA SANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:LATRINDA
Middle Name:SANDRA
Last Name:LATIMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEAUFORT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1946
Mailing Address - Country:US
Mailing Address - Phone:585-615-9849
Mailing Address - Fax:
Practice Address - Street 1:90 BEAUFORT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1946
Practice Address - Country:US
Practice Address - Phone:585-615-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse