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Individual

LARISSA GOURDET

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
A.N.P

Contact information

Practice address
997 GLEN COVE AVE, GLEN HEAD, NY 11545-1593
(516) 674-9144
Mailing address
997 GLEN COVE AVE, GLEN HEAD, NY 11545-1593
(516) 674-9144

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307969
NY

Other

Enumeration date
10/06/2016
Last updated
10/06/2016
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