Healthcare Provider Details

I. General information

NPI: 1912843293
Provider Name (Legal Business Name): LARISSA ROBERTSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LARISSA WRIGHT RN

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

1700 WHEELING ST
AURORA CO
80045-7211
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone: 303-399-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number290089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: