Jacqueline Latham, RN
Individual provider Active NPI Registered Nurse · Blanding, UT
NPI 1366813552 · NPPES record last updated Oct 13, 2015
Key facts
- NPI
- 1366813552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 5648004-3102 (UT)
- Practice address
- 196 E Center St
Blanding, UT 84511-2921 - Phone
- (435) 678-2723
- NPI assigned
- Oct 13, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5648004-3102 | UT | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 5648004-3102 | UT | Yes |
Addresses
Primary practice location
196 E Center St
Blanding, UT 84511-2921
Mailing address
196 E Center St
Blanding, UT 84511-2921
Other providers in Blanding, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.