Healthcare Provider Details

I. General information

NPI: 1053801894
Provider Name (Legal Business Name): LARISA LYNN HAMMOND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N HIGGINS AVE STE 6
MISSOULA MT
59802-4457
US

IV. Provider business mailing address

3300 WASHTENAW AVE STE 280
ANN ARBOR MI
48104-5184
US

V. Phone/Fax

Practice location:
  • Phone: 406-960-4698
  • Fax:
Mailing address:
  • Phone: 406-960-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberNURAPRNLIC130501
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number130501
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-130501
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: