Nicole Larsen, RN
Registered Nurse, Case Management in Red Lake, MN. Individual provider (NPI-1).
NPI number1639986334
StatusActive
Last updated in NPPESDec 16, 2024
Details
- NPI
- 1639986334
- Entity type
- Individual (NPI-1)
- Name
- Nicole Larsen
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 16, 2024
- Certification date
- Dec 12, 2024
- Last updated
- Dec 16, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WC0400X | Registered Nurse, Case Management | 2279664 | MN | Yes |
| 163WA0400X | Registered Nurse, Addiction (Substance Use Disorder) | 2279664 | MN | |
| 163WP0809X | Registered Nurse, Psych/Mental Health, Adult | 2279664 | MN |
Practice location
24760 Hospital DrRed Lake, MN 56671
Phone 218-679-0112 · Fax 218-679-0187
Mailing address
Po Box 497Red Lake, MN 56671-0497
Phone 218-679-0112 · Fax 218-679-0187
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