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General NPI Number Information
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NPI Number | 1588551097
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Entity Type | Individual
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Provider Name | LARISSA SHEREE ADDISON
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 4901 DAWN DR STE 3200
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City | LUMBERTON
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State | NC
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Zip | 28360-8288
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Country | US
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Telephone | 910-735-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 PARAMOUNT PKWY STE 220
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City | MORRISVILLE
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State | NC
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Zip | 27560-5490
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Country | US
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Telephone | 984-215-4111
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 314715
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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