Provider Demographics
NPI:1437555109
Name:GOISSE, LARRY J (CRNP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
Last Name:GOISSE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 LIVING PL
Mailing Address - Street 2:SUITE 2085
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206
Mailing Address - Country:US
Mailing Address - Phone:412-274-0303
Mailing Address - Fax:412-802-9156
Practice Address - Street 1:6425 LIVING PL
Practice Address - Street 2:SUITE 2085
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-274-0303
Practice Address - Fax:412-802-9156
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN577684363LP0808X
PASP014433363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245766310OtherPRACTICE NPI
PA1437555109Medicaid