Provider Demographics
NPI:1396283933
Name:LARISA BIZNICHUK MSN PMHNP-BC PLLC
Entity type:Organization
Organization Name:LARISA BIZNICHUK MSN PMHNP-BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BISNICHUK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:520-638-5997
Mailing Address - Street 1:6700 N ORACLE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7733
Mailing Address - Country:US
Mailing Address - Phone:520-638-5997
Mailing Address - Fax:520-638-6948
Practice Address - Street 1:6700 N ORACLE RD STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7733
Practice Address - Country:US
Practice Address - Phone:520-638-5997
Practice Address - Fax:520-638-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3414363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ135477Medicare PIN