| NPI | 1760030050 |
|---|---|
| Former Name | LARISSA KATHLEEN BRETTELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9336400) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN287176) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2019-08-29 |