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Individual

LARISSA FAITH GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1522 E A ST, CASPER, WY 82601-2254
(307) 234-6161
Mailing address
4227 MINK, CASPER, WY 82604-4509
(307) 234-6161

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA1038
WY
363A00000X
Physician Assistant
Primary
PA1038
WY

Other

Enumeration date
06/14/2022
Last updated
02/25/2023
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