Individual
LARISA ANATOLYEVNA DYAKOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
702 N 13TH ST, ARTESIA, NM 88210-1199
(575) 748-3333
(575) 736-8139
Mailing address
111 S MEMORIAL DR, LANCASTER, OH 43130-4361
(740) 655-2631
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
79627
NM
363LF0000X
Family Nurse Practitioner
0032705
OH
Other
Enumeration date
02/14/2023
Last updated
11/18/2024
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