Provider Demographics
NPI:1487362489
Name:LITEPLO, LARYSSA SOPHIA
Entity type:Individual
Prefix:
First Name:LARYSSA
Middle Name:SOPHIA
Last Name:LITEPLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 SW 154TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5049
Mailing Address - Country:US
Mailing Address - Phone:917-952-8729
Mailing Address - Fax:
Practice Address - Street 1:7435 SW 154TH PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-5049
Practice Address - Country:US
Practice Address - Phone:917-952-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF10220250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner