Provider Demographics
NPI:1700186632
Name:LATORRE, DWAYNE (RN)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:
Last Name:LATORRE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PARK AVE
Mailing Address - Street 2:APT. 14H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2553
Mailing Address - Country:US
Mailing Address - Phone:646-643-6818
Mailing Address - Fax:
Practice Address - Street 1:80 PARK AVE
Practice Address - Street 2:APT. 14H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2553
Practice Address - Country:US
Practice Address - Phone:646-643-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse