Provider Demographics
NPI:1972566966
Name:HASSAN, LATIFAT A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LATIFAT
Middle Name:A
Last Name:HASSAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LATIFAT
Other - Middle Name:A
Other - Last Name:SHIYANBADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,FNP
Mailing Address - Street 1:1549 PIUTE ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-5554
Mailing Address - Country:US
Mailing Address - Phone:760-252-8395
Mailing Address - Fax:760-252-8395
Practice Address - Street 1:DEPARTMENT OF THE ARMY,MARY WALKER CLINIC,BLD 170
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-7396
Practice Address - Fax:760-380-4409
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 14683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily