Provider Demographics
NPI:1326338369
Name:LARRISON, NICOLE LYNNE (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNE
Last Name:LARRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:STEFFENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-239-4100
Mailing Address - Fax:636-390-4341
Practice Address - Street 1:605 E BOONESLICK RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2127
Practice Address - Country:US
Practice Address - Phone:636-456-6103
Practice Address - Fax:636-456-6124
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007020021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily