Individual
MIA LATHAM
Active
Individual
MIA LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
547826
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28759834
—
NM
01
—
8Y0080
HMO BLUE
TX
01
—
8Y0082
BC/BS
TX
Enumeration date
06/21/2006
Last updated
07/09/2007
Update your record
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