Provider Demographics
NPI:1821431768
Name:LATIMER, LUKE (RN)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:LATIMER
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 1:131 MAPLE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1022
Mailing Address - Country:US
Mailing Address - Phone:845-264-5965
Mailing Address - Fax:
Practice Address - Street 1:131 MAPLE ST APT 9
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1022
Practice Address - Country:US
Practice Address - Phone:845-264-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse