Provider Demographics
NPI:1407496094
Name:KUCHYNSKA, LARISSA
Entity Type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:
Last Name:KUCHYNSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:KUCHYNSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1440 67TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-6286
Mailing Address - Country:US
Mailing Address - Phone:347-436-5919
Mailing Address - Fax:
Practice Address - Street 1:3201 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2625
Practice Address - Country:US
Practice Address - Phone:718-951-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse