Healthcare Provider Details

I. General information

NPI: 1467247056
Provider Name (Legal Business Name): LRC PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10177 HANDLINE CHUTE ST
LAS VEGAS NV
89166-1370
US

IV. Provider business mailing address

10177 HANDLINE CHUTE ST
LAS VEGAS NV
89166-1370
US

V. Phone/Fax

Practice location:
  • Phone: 334-701-4961
  • Fax:
Mailing address:
  • Phone: 334-701-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LARHONDA CRAIG
Title or Position: FNP/OWNER
Credential: FNP
Phone: 334-701-4961