Individual
NICOLE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
24760 HOSPITAL DR, RED LAKE, MN 56671
(218) 679-0112
(218) 679-0187
Mailing address
PO BOX 497, RED LAKE, MN 56671-0497
(218) 679-0112
(218) 679-0187
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
2279664
MN
163WC0400X
Case Management Registered Nurse
Primary
2279664
MN
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
2279664
MN
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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