Larisa Anatolyevna Lysak
Nurse Practitioner, Family in North Highlands, CA. Individual provider (NPI-1).
NPI number1700967908
StatusActive
Last updated in NPPESSep 16, 2020
Details
- NPI
- 1700967908
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Larisa Anatolyevna Lysak
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 17, 2006
- Certification date
- Sep 16, 2020
- Last updated
- Sep 16, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 16740 | CA | Yes |
Practice location
4815 Watt AveNorth Highlands, CA 95660-5108
Phone 855-354-2242
Mailing address
1860 Howe Ave Ste 440Sacramento, CA 95825-1098
Phone 916-569-8484
Other practice locations
8100 Timberlake Way Ste A
Sacramento, CA 95823-5409
Sacramento, CA 95823-5409
Phone 916-681-2539 · Fax 916-681-2469
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 9 Family Nurse Practitioner providers in North Highlands · All 331 providers in North Highlands
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