Doctor Name: | LARISA ALEXEYEVNA YARCZOWER |
NPI Number: | 1043394216 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA003388L |
Business Practice Address: | 1000 E. Mountain Drive Wilkes-barre, PA - 18702 |
Business Phone Number: | 5708206150 |
Business Fax Number: | 5703423316 |
Mailing Address: | 254 Deer Run Drive, MOUNTAINTOP |
State: | PA |
Postal Code: | 18707 |
Phone Number: | 5704740610 |
Fax Number: | 5703423316 |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 09/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA003388L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |