Provider Demographics
NPI:1124156013
Name:LARSEN, SHEILA DARLENE (B A)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:DARLENE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:B A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 KITTRELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:TN
Mailing Address - Zip Code:38461-5017
Mailing Address - Country:US
Mailing Address - Phone:931-796-5916
Mailing Address - Fax:193-179-6128
Practice Address - Street 1:704 HIGHWAY 100 STE 101
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1172
Practice Address - Country:US
Practice Address - Phone:931-792-3573
Practice Address - Fax:931-792-9330
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator