Healthcare Provider Details

I. General information

NPI: 1548355068
Provider Name (Legal Business Name): JERRIE A LARSEN BS RN CRA CWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 NE 52ND ST
SEATTLE WA
98105-3344
US

IV. Provider business mailing address

2012 NE 52ND ST
SEATTLE WA
98105-3344
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-9948
  • Fax:
Mailing address:
  • Phone: 206-523-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN00046956
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberRN00046956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: