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General NPI Number Information
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NPI Number | 1336429190
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Entity Type | Individual
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Provider Name | NICOLE LARSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1325 S CLIFF AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1007
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Country | US
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Telephone | 605-322-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 W THOMAS CIR APT 2
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City | BRANDON
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State | SD
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Zip | 57005-3037
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Country | US
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Telephone | 605-660-2915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR000758
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License Number State | SD
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