| NPI | 1043812449 |
|---|---|
| Former Name | LARISSA DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1017383) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1017383) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1017383) | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2022-04-14 |