Provider Demographics
NPI:1174189393
Name:LARSON IVERSON, SIRI ANN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:ANN
Last Name:LARSON IVERSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:SIRI
Other - Middle Name:ANN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5515 PANTHER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9396
Mailing Address - Country:US
Mailing Address - Phone:253-208-5170
Mailing Address - Fax:
Practice Address - Street 1:57 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2929
Practice Address - Country:US
Practice Address - Phone:877-869-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60896330176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty