Provider Demographics
NPI:1801601018
Name:PETERMAN, LARISA ANNETTE
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:ANNETTE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21818 SHIRK RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8200
Mailing Address - Country:US
Mailing Address - Phone:937-645-7661
Mailing Address - Fax:
Practice Address - Street 1:21818 SHIRK RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8200
Practice Address - Country:US
Practice Address - Phone:937-645-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care