Larissa J Bruck, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

12797278-8901 Issued in UT

Practice address

3741 W 12600 S
Riverton, UT 84065-7215

Phone

(801) 285-4000

NPI assigned

Apr 27, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Larissa J Yannaccone Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1932634938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 N CENTER ST STE 800",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437406",
            "telephone_number": "801-990-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3741 W 12600 S",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657215",
            "telephone_number": "801-285-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3705 Medical Pkwy Ste 570",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787051024",
            "country_code": "US",
            "telephone_number": "512-454-2554",
            "fax_number": "512-454-2824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCK",
        "first_name": "LARISSA",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP134258",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "12797278-8901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISSA",
            "last_name": "YANNACCONE",
            "middle_name": "J",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aaron Brown
• Alexandra Brown
• Harold Call Brown, CSW
• Henna Kealohilani Brown Jr., CRNA
• Wayne D Brown, DDS
• Katherine Brunner, DNP
• Cristy Bruso
• Nellie Bubb, OTR/L
• Megan Harris Buchanan, NP
• Jayson Tyler Buhler, OD

• Certified Registered Nurse Anesthetist in Riverton, UT
• Providers in Riverton, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.