Provider Demographics
NPI:1841528908
Name:LATOUR, ELLEN ANN (RN/NP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANN
Last Name:LATOUR
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:780 CHESTNUT ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1637
Mailing Address - Country:US
Mailing Address - Phone:413-787-2800
Mailing Address - Fax:413-787-2822
Practice Address - Street 1:780 CHESTNUT ST
Practice Address - Street 2:SUITE 23
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1637
Practice Address - Country:US
Practice Address - Phone:413-787-2800
Practice Address - Fax:413-787-2822
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN160329363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001611801Medicare PIN
MA001611802Medicare PIN