Individual
OLIVIA MAE LARUSSA
Active
Individual
OLIVIA MAE LARUSSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
TL2763
SC
363AM0700X
Medical Physician Assistant
Primary
PA200001702
DC
363AS0400X
Surgical Physician Assistant
2763
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3448PA
—
SC
Enumeration date
07/07/2017
Last updated
11/21/2023
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