Provider Demographics
NPI:1689641383
Name:LARSON, NOEL K (NP)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:K
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-595-2505
Mailing Address - Fax:508-854-0650
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-595-2505
Practice Address - Fax:508-854-0650
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherTHREE RIVERS
MA325121Medicaid
AA3671OtherHARVARD PILGRIM HEALTHCAR
500011895OtherRAILROAD MEDICARE
NP1277OtherMEDICARE B
54933OtherFALLON COMMUNITY HEALTH P
NP1277OtherBLUE SHIELD IDEMNITY
042472266OtherPRIVATE HEALTH CARE SYSTE
4142201OtherMVP HEALTH CARE
NP1277OtherBLUE CARE ELECT
NP1277OtherBLUE SHIELD HMO BLUE
NP1277OtherBLUE CARE ELECT
NP1277OtherBLUE SHIELD HMO BLUE