Provider Demographics
NPI:1154971406
Name:SUNDERLAND, ANNA LARISA LAWYER (MSN, CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNA LARISA
Middle Name:LAWYER
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:MSN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 PACIFIC ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-5510
Mailing Address - Country:US
Mailing Address - Phone:347-882-5655
Mailing Address - Fax:
Practice Address - Street 1:1391 PACIFIC ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5510
Practice Address - Country:US
Practice Address - Phone:347-882-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421390363LW0102X, 367A00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty