Individual
LARISSA M HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 772-4702
(918) 458-3464
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 772-4702
(918) 458-3464
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1905
OK
Other
Enumeration date
02/08/2013
Last updated
04/12/2016
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