Provider Demographics
NPI:1548343247
Name:FRANCHUK, LARISSA C (PAC)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:C
Last Name:FRANCHUK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:C
Other - Last Name:OLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:8406 E SHEA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6659
Mailing Address - Country:US
Mailing Address - Phone:480-998-1158
Mailing Address - Fax:480-998-0123
Practice Address - Street 1:8406 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6659
Practice Address - Country:US
Practice Address - Phone:480-998-1158
Practice Address - Fax:480-998-0123
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548343247OtherNPI
VA006228P05Medicare ID - Type Unspecified