Healthcare Provider Details

I. General information

NPI: 1013037746
Provider Name (Legal Business Name): LARRY DALE GERMAIN NP ARNP IN WA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 EAGLE CREST WAY CLALLAM BAY CORRECTIONS CENTER
CLALLUM BAY WA
98326-9723
US

IV. Provider business mailing address

PO BOX 2132
SEQUIM WA
98382
US

V. Phone/Fax

Practice location:
  • Phone: 360-963-3237
  • Fax: 360-963-3287
Mailing address:
  • Phone: 360-681-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30005570
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: