Provider Demographics
NPI:1922243948
Name:KATERENCHUK, LARISA V
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:V
Last Name:KATERENCHUK
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 1:417 NW BATTAGLIA AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5260
Mailing Address - Country:US
Mailing Address - Phone:971-998-5424
Mailing Address - Fax:503-666-9653
Practice Address - Street 1:417 NW BATTAGLIA AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5260
Practice Address - Country:US
Practice Address - Phone:971-998-5424
Practice Address - Fax:503-666-9653
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840254RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse