Provider Demographics
NPI:1932171386
Name:LATTIMORE, LOIS EILEEN (NP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:EILEEN
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 W ORANGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1116
Mailing Address - Country:US
Mailing Address - Phone:520-742-4183
Mailing Address - Fax:520-742-4110
Practice Address - Street 1:1891 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1116
Practice Address - Country:US
Practice Address - Phone:520-742-4183
Practice Address - Fax:520-742-4110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ308363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP07477Medicare UPIN