Provider Demographics
NPI:1467665943
Name:NORMAN, LARISSA S (RN, BSN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:S
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 TATE SPRINGS RD
Mailing Address - Street 2:STE A2
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1100
Mailing Address - Country:US
Mailing Address - Phone:434-846-2244
Mailing Address - Fax:
Practice Address - Street 1:1715 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1101
Practice Address - Country:US
Practice Address - Phone:434-846-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457423550OtherGROUP NPI
VA1457423550OtherGROUP NPI