Healthcare Provider Details

I. General information

NPI: 1225400088
Provider Name (Legal Business Name): LARRISE WILLIFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 SNOW RD
PARMA OH
44130-1002
US

IV. Provider business mailing address

12301 SNOW RD
PARMA OH
44130-1002
US

V. Phone/Fax

Practice location:
  • Phone: 216-210-0774
  • Fax:
Mailing address:
  • Phone: 216-210-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number405298
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number405298
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number45298
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number405298
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number405298
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number405298
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number405298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: