Provider Demographics
NPI:1174911630
Name:LATURNAU, LINDSEY ANNE (ATC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANNE
Last Name:LATURNAU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HYDE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-4611
Mailing Address - Country:US
Mailing Address - Phone:603-785-3706
Mailing Address - Fax:
Practice Address - Street 1:1 CUNNINGHAM SQ
Practice Address - Street 2:ALUMNI HALL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-865-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT00331207QS0010X
MEAT441207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine