Provider Demographics
NPI:1679049191
Name:LARRISON, CAROLINE NORA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NORA
Last Name:LARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:NORA
Other - Last Name:GOING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2313 DUBONNET DR # 2
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8865
Mailing Address - Country:US
Mailing Address - Phone:610-844-1323
Mailing Address - Fax:
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5999
Practice Address - Country:US
Practice Address - Phone:315-801-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant