Provider Demographics
NPI:1548010093
Name:LATHAM, JONI JOYCE
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:JOYCE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0646
Mailing Address - Country:US
Mailing Address - Phone:307-283-3636
Mailing Address - Fax:307-283-2898
Practice Address - Street 1:420 1/2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729
Practice Address - Country:US
Practice Address - Phone:307-283-3636
Practice Address - Fax:307-283-2898
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker