Provider Demographics
NPI:1295079218
Name:LATZEN, DEBRA M (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:LATZEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 TOWNEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2812
Mailing Address - Country:US
Mailing Address - Phone:516-581-8533
Mailing Address - Fax:
Practice Address - Street 1:3906 TOWNEHOUSE DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2812
Practice Address - Country:US
Practice Address - Phone:516-581-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606902-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health