Provider Demographics
NPI:1245415926
Name:KRATZER, LARISSA FUNK (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:FUNK
Last Name:KRATZER
Suffix:
Gender:F
Credentials:CNM
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Other - First Name:
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Mailing Address - Street 1:11750 SW BARNES ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5911
Mailing Address - Country:US
Mailing Address - Phone:503-416-9922
Mailing Address - Fax:503-416-9971
Practice Address - Street 1:11750 SW BARNES ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5911
Practice Address - Country:US
Practice Address - Phone:503-416-9922
Practice Address - Fax:503-416-9971
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR200950115NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife