Provider Demographics
NPI:1760788301
Name:HIMES, LARISSA MARIE
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:MARIE
Last Name:HIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SAN JOAQUIN DR
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2244
Mailing Address - Country:US
Mailing Address - Phone:530-336-0427
Mailing Address - Fax:
Practice Address - Street 1:340 SAN JOAQUIN DR
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2244
Practice Address - Country:US
Practice Address - Phone:530-336-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-30
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide