Provider Demographics
NPI:1972769388
Name:NESS, LARAYNE ANNETTE (ARNP)
Entity type:Individual
Prefix:MS
First Name:LARAYNE
Middle Name:ANNETTE
Last Name:NESS
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:511 HALE ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1829
Mailing Address - Country:US
Mailing Address - Phone:586-531-8882
Mailing Address - Fax:
Practice Address - Street 1:1000 WILLOW CREEK RD
Practice Address - Street 2:SUITE G
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:928-458-7343
Practice Address - Fax:928-257-4422
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2013-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60143760363LF0000X
AZAP3075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ364981Medicaid