Individual
MRS. LARISSA S SULTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
115 WILLOW LAKE DR, OXFORD, MI 48371-6376
(248) 672-0526
Mailing address
115 WILLOW LAKE DR, OXFORD, MI 48371-6376
(248) 672-0526
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704276540
MI
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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