Individual
LARISA POGORELOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3150
Mailing address
24828 TODDY LN, FARMINGTON HILLS, MI 48335-2075
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
4704320981
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704320981
MICHIGAN BOARD OF NURSING
MI
Enumeration date
12/23/2022
Last updated
12/23/2022
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