Provider Demographics
NPI:1205135886
Name:BYK, LARISA (RN)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:
Last Name:BYK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAKES CIR
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-4341
Mailing Address - Country:US
Mailing Address - Phone:508-769-4762
Mailing Address - Fax:
Practice Address - Street 1:4 OAKES CIR
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-4341
Practice Address - Country:US
Practice Address - Phone:508-769-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN47909163W00000X
MARN2258517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse