Individual
KIM MARIE LATTERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
115 HICKORY DR, MANCHESTER, PA 17345-9502
(717) 266-6784
Mailing address
115 HICKORY DR, MANCHESTER, PA 17345-9502
(717) 266-6784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0002815
MD
363AM0700X
Medical Physician Assistant
Primary
MA001899L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1565458
GATEWAY-WMG
PA
01
—
1933965
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/03/2006
Last updated
12/19/2011
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