Individual
MRS. LARISSA GBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9711 WASHINGTON BLVD SUITE 550, GAITHERSBURG, MD 20878
(301) 966-2558
Mailing address
3731 SPICEBUSH DR, URBANA, MD 21704-7879
(240) 426-3133
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R194251
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R194251
NP LICENSE
MD
Enumeration date
01/08/2019
Last updated
09/29/2021
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