Provider Demographics
NPI:1720639933
Name:RODRIGUEZ, LARISSA LASO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LARISSA
Middle Name:LASO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Mailing Address - Street 1:8243 MEADOWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2329
Mailing Address - Country:US
Mailing Address - Phone:804-800-6600
Mailing Address - Fax:804-806-4422
Practice Address - Street 1:8243 MEADOWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2329
Practice Address - Country:US
Practice Address - Phone:804-800-6660
Practice Address - Fax:804-806-4422
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024178283363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care