Individual
KELLY DARRAGH LATTANZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3322 N BROAD ST, PHILADELPHIA, PA 19140-5185
(215) 707-1800
(215) 707-3644
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-1800
(215) 707-3644
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN527774L
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP009526
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022508560001
—
PA
Enumeration date
09/19/2007
Last updated
03/28/2018
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