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NPI Code Detail

MEDICARE: LARYSSA SOPHIA LITEPLO FNP

MEDICARE: LARYSSA SOPHIA LITEPLO FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner10002063OR
2363L00000XNurse Practitioner61379599WA

General Provider Information

NPI Number : 1487362489
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARYSSA SOPHIA LITEPLO FNP
Provider Business Mailing Address
First Line : 1015 NW 22ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-3025
Country : US
Telephone Number : 917-952-8729
Fax Number :
Provider Business Practice Location Address
First Line : 1015 NW 22ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-3025
Country : US
Telephone Number : 503-413-7260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2022
Last Update Date : 01/07/2026

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Directions to “ LARYSSA SOPHIA LITEPLO FNP” Practice Location

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