Basic Information
| Provider Information | |||||||||
| NPI: | 1538586128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATIMER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 JEFFERSON PLZ | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126014035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454735900 | ||||||||
| FaxNumber: | 8454736692 | ||||||||
| Practice Location | |||||||||
| Address1: | 773 GREGORY CT | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125282026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453899854 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 795595 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.