Provider Demographics
NPI:1003205832
Name:LARIMORE, NATHAN PAUL
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:PAUL
Last Name:LARIMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NORTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5748
Mailing Address - Country:US
Mailing Address - Phone:586-463-5831
Mailing Address - Fax:586-563-4742
Practice Address - Street 1:309 NORTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5748
Practice Address - Country:US
Practice Address - Phone:586-463-5831
Practice Address - Fax:586-563-4742
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501006486237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist