Provider Demographics
NPI:1053801894
Name:HAMMOND, LARISA LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:LYNN
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WASHTENAW AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5184
Mailing Address - Country:US
Mailing Address - Phone:406-960-4698
Mailing Address - Fax:
Practice Address - Street 1:127 N HIGGINS AVE STE 6
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4457
Practice Address - Country:US
Practice Address - Phone:406-960-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNURAPRNLIC1305012084A0401X
MT130501363LF0000X
MTNUR-APRN-LIC-130501363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily