Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP30003421 | WA |
NPI | 1003975822 |
---|---|
Provider Name | Ms. Christine J. Larsen |
First Address | Tacoma, WA 98418-7915 |
Second Address | Tacoma, WA 98418-7915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170176 | L&I (01) | WA |
9652516 | (05) | WA |
S68497 | (02) | WA |