Provider Demographics
NPI:1588385355
Name:LARRICK, STEPHANIE RAE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:LARRICK
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6033
Mailing Address - Country:US
Mailing Address - Phone:781-762-0471
Mailing Address - Fax:
Practice Address - Street 1:910 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6033
Practice Address - Country:US
Practice Address - Phone:781-762-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2371088363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health