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Individual
MRS. LARISSA DIANE WATSON
Active
Individual
MRS. LARISSA DIANE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005553A
IN
363LA2200X
Adult Health Nurse Practitioner
209023916
IL
363LA2200X
Adult Health Nurse Practitioner
71005553A
IN
363LF0000X
Family Nurse Practitioner
209023916
IL
363LP2300X
Primary Care Nurse Practitioner
28208703A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201312530
—
IN
Enumeration date
06/15/2015
Last updated
08/14/2026
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