Provider Demographics
NPI:1679201735
Name:GREER, LARISSA KEYAIRA
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:KEYAIRA
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 WALTERS LN APT 203
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3118
Mailing Address - Country:US
Mailing Address - Phone:202-580-3213
Mailing Address - Fax:
Practice Address - Street 1:1434 SARATOGA AVE NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1909
Practice Address - Country:US
Practice Address - Phone:202-300-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant