Provider Demographics
NPI:1982426714
Name:DIABETES CARE AND WELLNESS MANAGEMENT LLC
Entity type:Organization
Organization Name:DIABETES CARE AND WELLNESS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:LATTIBEAUDIERE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:954-487-9057
Mailing Address - Street 1:11801 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11801 TRAILRIDGE DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2835
Practice Address - Country:US
Practice Address - Phone:954-487-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty