Individual
TISHA MARIE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
201910861NP-PP
OR
363LF0000X
Family Nurse Practitioner
201500780NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165772
—
OR
Enumeration date
02/09/2015
Last updated
10/12/2021
Update your record
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