Provider Demographics
NPI:1568274108
Name:LATAWIEC, LUCIA CARMEL
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:CARMEL
Last Name:LATAWIEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 190TH LN NE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-9704
Mailing Address - Country:US
Mailing Address - Phone:651-440-6521
Mailing Address - Fax:
Practice Address - Street 1:5243 190TH LN NE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-9704
Practice Address - Country:US
Practice Address - Phone:651-440-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant