Provider Demographics
NPI:1902925365
Name:LATTERELL, JENNIFER HOLMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HOLMES
Last Name:LATTERELL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5036
Mailing Address - Country:US
Mailing Address - Phone:319-369-7393
Mailing Address - Fax:319-369-8351
Practice Address - Street 1:1201 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4009
Practice Address - Country:US
Practice Address - Phone:319-730-7300
Practice Address - Fax:319-739-7368
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN18509207Q00000X
MN49315207Q00000X
IA4510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine