Healthcare Provider Details

I. General information

NPI: 1780121293
Provider Name (Legal Business Name): CHRISTINE MARIE LARSEN MSNRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LOOMIS ST
BEDFORD MA
01730-2248
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-2900
  • Fax:
Mailing address:
  • Phone: 781-674-2900
  • Fax: 781-275-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number283535
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number283535
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: