Provider Demographics
NPI:1700128659
Name:CAMANO-SELCA, LARISSA (RN, BSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:CAMANO-SELCA
Suffix:
Gender:F
Credentials:RN, BSN, FNP-BC
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:CAMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 EATON CT
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4052
Mailing Address - Country:US
Mailing Address - Phone:203-917-9272
Mailing Address - Fax:
Practice Address - Street 1:1202 EATON CT
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4052
Practice Address - Country:US
Practice Address - Phone:203-917-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily