Provider Demographics
NPI:1720330160
Name:LATIMORE, PIERRETTE GENIA (CNM)
Entity Type:Individual
Prefix:MS
First Name:PIERRETTE
Middle Name:GENIA
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:1400 FOREST GLEN RD STE 525
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1466
Practice Address - Country:US
Practice Address - Phone:301-593-8101
Practice Address - Fax:301-593-1537
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2023-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR183914367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751500Medicaid