Provider Demographics
NPI:1194566778
Name:LATTA, AIMEE (RN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LATTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 GRAND CONCOURSE FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5204
Mailing Address - Country:US
Mailing Address - Phone:718-714-7300
Mailing Address - Fax:
Practice Address - Street 1:2432 GRAND CONCOURSE FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-714-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY759798163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice