Provider Demographics
NPI:1710324918
Name:LARSON, DEANNA (RN CCM CDOE)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN CCM CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CAMP DIXIE RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-2823
Mailing Address - Country:US
Mailing Address - Phone:401-573-9210
Mailing Address - Fax:
Practice Address - Street 1:264 CAMP DIXIE RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-2823
Practice Address - Country:US
Practice Address - Phone:401-573-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN22489163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator