| Nicole Larson Llc | |
|
101 5th St E Ste 207 Northfield MN 55057-2076 | |
| (507) 301-6741 | |
| Not Available |
| Full Name | Nicole Larson Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 5th St E Ste 207, Northfield, Minnesota |
| Authorized Official Name and Position | Nicole Larson (OWNER) |
| Authorized Official Contact | 5073016741 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Larson Llc 101 5th St E Ste 207 Northfield MN 55057-2076 Ph: () - | Nicole Larson Llc 101 5th St E Ste 207 Northfield MN 55057-2076 Ph: (507) 301-6741 |
| NPI Number | 1477221075 |
|---|---|
| Provider Enumeration Date | 08/31/2021 |
| Last Update Date | 08/31/2021 |
| Certification Date | 08/31/2021 |
| Medicare PECOS PAC ID | 5799123089 |
|---|---|
| Medicare Enrollment ID | O20240405000732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477221075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nicole Elizabeth Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568715803 PECOS PAC ID: 6608214994 Enrollment ID: I20240405000782 |
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