Individual
LATHA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
14131 MIDWAY ROAD, SUITE 620, ADDISON, TX 75001-3669
(972) 249-0200
(972) 249-0206
Mailing address
14131 MIDWAY ROAD, SUITE 620, ADDISON, TX 75001-3669
(972) 249-0200
(972) 249-0206
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
739362
TX
363L00000X
Nurse Practitioner
Primary
739362
TX
Other
Enumeration date
09/23/2011
Last updated
04/17/2013
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