Provider Demographics
NPI:1760700678
Name:LARSEN, ERIC (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 W DAYTON AIRPORT RD
Mailing Address - Street 2:PO BOX 900
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-6319
Mailing Address - Country:US
Mailing Address - Phone:360-426-4433
Mailing Address - Fax:
Practice Address - Street 1:2321 W DAYTON AIRPORT RD
Practice Address - Street 2:POST OFFICE BOX 900
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-6319
Practice Address - Country:US
Practice Address - Phone:360-426-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60104511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily