Provider Demographics
NPI:1770881443
Name:ERKAEV, LARISA (RN)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:ERKAEV
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 1:2217 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2531
Mailing Address - Country:US
Mailing Address - Phone:720-398-9666
Mailing Address - Fax:720-502-5082
Practice Address - Street 1:2217 CHAMPA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2531
Practice Address - Country:US
Practice Address - Phone:720-398-9666
Practice Address - Fax:720-502-5082
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1622026163WA0400X, 163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health