Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 202100185NP-PP | OR |
NPI | 1033707708 |
---|---|
Provider Name | Monelle Larissa Burrus |
First Address | Bend, OR 97702-3765 |
Second Address | Bend, OR 97701-3822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |