Individual
MRS. JACQUELINE SUZETTE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1313 BROADWAY STE 200, TACOMA, WA 98402-3400
(253) 209-0187
Mailing address
1313 BROADWAY STE 200, TACOMA, WA 98402-3400
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60702009
WA
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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