| NPI | 1831823780 |
|---|---|
| Former Name | NICOLE LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner Neonatal, Critical Care (Licence: MT NUR-APRN-LIC-196347) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2024-04-08 |