Individual
DR. NICOLE LYNN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, PMHNP-BC
Contact information
Practice address
149 THOMPSON AVE E STE 150, WEST ST PAUL, MN 55118-3238
(651) 450-0860
(651) 450-0759
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-5427
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
1574425
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1563
MN
Other
Enumeration date
03/27/2006
Last updated
10/21/2022
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