Provider Demographics
NPI:1366286734
Name:DENNIE, LARRA (CNM)
Entity type:Individual
Prefix:
First Name:LARRA
Middle Name:
Last Name:DENNIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 NEW LAIR RD
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-4538
Mailing Address - Country:US
Mailing Address - Phone:859-569-8070
Mailing Address - Fax:
Practice Address - Street 1:3652 NEW LAIR RD
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-4538
Practice Address - Country:US
Practice Address - Phone:859-569-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4023500176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife