Provider Demographics
NPI:1457916801
Name:LATIMER, DAVID JR (RN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LATIMER
Suffix:JR
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 1:235 JACOB ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2229
Mailing Address - Country:US
Mailing Address - Phone:516-254-1737
Mailing Address - Fax:
Practice Address - Street 1:235 JACOB ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2229
Practice Address - Country:US
Practice Address - Phone:516-254-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717728163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical