Individual
MRS. SHANNON MICHAL LATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4420 76TH ST NE, MARYSVILLE, WA 98270-3726
(360) 651-7490
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AP60098107
WA
363LF0000X
Family Nurse Practitioner
Primary
AP60098107
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0254476
LABOR & INDUSTRIES
WA
05
—
2003611
—
WA
05
—
9662628
—
WA
Enumeration date
08/02/2009
Last updated
12/13/2012
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