Provider Demographics
NPI:1114217346
Name:IGNATOVICH, LARISA (RN)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:
Last Name:IGNATOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:IGNATOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8321 21ST AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2445
Mailing Address - Country:US
Mailing Address - Phone:347-312-4522
Mailing Address - Fax:
Practice Address - Street 1:500 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2902
Practice Address - Country:US
Practice Address - Phone:212-293-3000
Practice Address - Fax:212-293-3020
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse