Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP126368 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP126368 | TX |
NPI | 1063818441 |
---|---|
Provider Name | Larisa Neretina |
First Address | Carrollton, TX 75010-4635 |
Second Address | Mckinney, TX 75071-7074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2014 |
Last Update Date | 09/02/2022 |