Provider Demographics
NPI:1255884961
Name:LATTMAN, LARA (CNS, LDN)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:LATTMAN
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS, LDN
Mailing Address - Street 1:637 CAWLEY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-4563
Mailing Address - Country:US
Mailing Address - Phone:301-518-5414
Mailing Address - Fax:
Practice Address - Street 1:637 CAWLEY DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4563
Practice Address - Country:US
Practice Address - Phone:301-518-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3792133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist