Provider Demographics
NPI:1194781302
Name:LATVALA, NICOLE J (APRN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:J
Last Name:LATVALA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:GERRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9825 SHANNON WOODS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-634-2000
Mailing Address - Fax:316-634-2321
Practice Address - Street 1:9825 SHANNON WOODS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-634-2000
Practice Address - Fax:316-634-2321
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics