Provider Demographics
NPI:1669431813
Name:LATHERO, VICKIE L (CRNP)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:LATHERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4927
Mailing Address - Country:US
Mailing Address - Phone:814-946-5411
Mailing Address - Fax:
Practice Address - Street 1:20 SHERATON DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-9316
Practice Address - Country:US
Practice Address - Phone:814-946-5411
Practice Address - Fax:814-940-8417
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN311834L163W00000X
PASP008783363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097021Medicare ID - Type Unspecified
Q60087Medicare UPIN