Individual
LARISSA BRIAUN HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
87520 BAY RD, CHRISTMAS VALLEY, OR 97641-2233
(541) 947-6021
(541) 576-3000
Mailing address
35 S G ST, LAKEVIEW, OR 97630-1817
(541) 947-6021
(541) 219-8114
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/16/2022
Last updated
02/16/2022
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