Individual
MRS. LARISSA ANN FAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1336 AVALON ST, KLAMATH FALLS, OR 97603-4423
(541) 892-4415
Mailing address
PO BOX 765, MERRILL, OR 97633-0765
(541) 892-4415
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201701461RN
OR
163WS0200X
School Registered Nurse
201701461RN
OR
Other
Enumeration date
04/29/2024
Last updated
04/30/2024
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