Provider Demographics
NPI:1396432357
Name:LARSON, CHARISSA (MS, IBCLC)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HEALTHPLEX PKWY
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9749
Mailing Address - Country:US
Mailing Address - Phone:405-515-3532
Mailing Address - Fax:
Practice Address - Street 1:3300 HEALTHPLEX PKWY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9749
Practice Address - Country:US
Practice Address - Phone:405-515-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN