Basic Information
| Provider Information | |||||||||
| NPI: | 1659998581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATSON | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018873720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179224442 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603476971 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 153972 | CT | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 8926 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.