Provider Demographics
NPI:1104564020
Name:JOOS, LARISSA ANNE (CD(DONA), PCD(DONA))
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:ANNE
Last Name:JOOS
Suffix:
Gender:F
Credentials:CD(DONA), PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9907 ASHMEADE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8393
Mailing Address - Country:US
Mailing Address - Phone:540-940-9457
Mailing Address - Fax:
Practice Address - Street 1:9907 ASHMEADE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8393
Practice Address - Country:US
Practice Address - Phone:540-940-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14766374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula