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Individual

MRS. LARISSA DIANE WATSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
7320 E 86TH ST STE 100, INDIANAPOLIS, IN 46256-1250
(463) 999-9179
(463) 999-9179
Mailing address
7320 E 86TH ST STE 100, INDIANAPOLIS, IN 46256-1250
(463) 999-9179
(463) 999-9179

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71005553A
IN
363LA2200X
Adult Health Nurse Practitioner
209023916
IL
363LA2200X
Adult Health Nurse Practitioner
71005553A
IN
363LF0000X
Family Nurse Practitioner
Primary
209023916
IL
363LP2300X
Primary Care Nurse Practitioner
28208703A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201312530
IN
Enumeration date
06/15/2015
Last updated
04/18/2025
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