Provider Demographics
NPI:1235792060
Name:JURSICH, LARISSA (PCD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:JURSICH
Suffix:
Gender:F
Credentials:PCD
Other - Prefix:
Other - First Name:RISS
Other - Middle Name:
Other - Last Name:JURSICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCD
Mailing Address - Street 1:5134 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3460
Mailing Address - Country:US
Mailing Address - Phone:630-209-8184
Mailing Address - Fax:
Practice Address - Street 1:5134 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3460
Practice Address - Country:US
Practice Address - Phone:630-209-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula