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NPI Code Detail

MEDICARE: NICOLE LARSEN MD

MEDICARE:   NICOLE  LARSEN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician87325-20WI

General Provider Information

NPI Number : 1033851183
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LARSEN MD
Provider Business Mailing Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-9070
Country : US
Telephone Number : 214-648-7312
Fax Number :
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number : 214-648-7312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2022
Last Update Date : 06/15/2026

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Directions to “ NICOLE LARSEN MD” Practice Location

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