Individual
LARISA YUSHUVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7741 170TH ST, FRESH MEADOWS, NY 11366-1345
(646) 752-0564
Mailing address
7741 170TH ST, FRESH MEADOWS, NY 11366-1345
(646) 752-0564
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
519811
NY
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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