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General NPI Number Information
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NPI Number | 1053801894
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Entity Type | Individual
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Provider Name | LARISA LYNN HAMMOND APRN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 127 N HIGGINS AVE STE 6
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City | MISSOULA
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State | MT
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Zip | 59802-4457
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Country | US
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Telephone | 406-960-4698
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 WASHTENAW AVE STE 280
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City | ANN ARBOR
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State | MI
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Zip | 48104-5184
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Country | US
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Telephone | 406-960-4698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | NURAPRNLIC130501
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 130501
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NUR-APRN-LIC-130501
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License Number State | MT
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