Healthcare Provider Details

I. General information

NPI: 1144093238
Provider Name (Legal Business Name): DEENA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

1301 S SUBURBAN DR
SIOUX FALLS SD
57110-3760
US

V. Phone/Fax

Practice location:
  • Phone: 605-929-5165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR045770
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: