Provider Demographics
NPI:1013037746
Name:GERMAIN, LARRY DALE (NP ARNP IN WA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DALE
Last Name:GERMAIN
Suffix:
Gender:M
Credentials:NP ARNP IN WA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2132
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-681-0943
Mailing Address - Fax:
Practice Address - Street 1:1830 EAGLE CREST WAY
Practice Address - Street 2:CLALLAM BAY CORRECTIONS CENTER
Practice Address - City:CLALLUM BAY
Practice Address - State:WA
Practice Address - Zip Code:98326-9723
Practice Address - Country:US
Practice Address - Phone:360-963-3237
Practice Address - Fax:360-963-3287
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005570363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health