Provider Demographics
NPI:1528895851
Name:KREUTZER, LARISSA KAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:KAYE
Last Name:KREUTZER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:KAYE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37254 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ROGGEN
Mailing Address - State:CO
Mailing Address - Zip Code:80652-9425
Mailing Address - Country:US
Mailing Address - Phone:720-251-1126
Mailing Address - Fax:
Practice Address - Street 1:1355 RIVERSIDE AVE STE D
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4366
Practice Address - Country:US
Practice Address - Phone:970-508-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000133-NP363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner