Provider Demographics
NPI:1386375905
Name:LARSON, NICOLE YVONNE (WHNP, CNM)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:YVONNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 SANDIFUR PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8028
Mailing Address - Country:US
Mailing Address - Phone:509-943-8839
Mailing Address - Fax:509-943-8851
Practice Address - Street 1:9613 SANDIFUR PKWY STE A
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8028
Practice Address - Country:US
Practice Address - Phone:509-943-8839
Practice Address - Fax:509-943-8851
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61288984163WW0101X
WAAP61315151176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory