Healthcare Provider Details

I. General information

NPI: 1982508149
Provider Name (Legal Business Name): NOELLE LARSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 9TH ST
CORALVILLE IA
52241-1575
US

IV. Provider business mailing address

2240 9TH ST
CORALVILLE IA
52241-1575
US

V. Phone/Fax

Practice location:
  • Phone: 319-800-5564
  • Fax: 319-205-0058
Mailing address:
  • Phone: 319-800-5564
  • Fax: 319-205-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG194560
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: