Basic Information
| Provider Information | |||||||||
| NPI: | 1861968166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATTA | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 N 2ND ST APT 112 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554013336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124198916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 SMITH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512206000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 2030515 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.