Provider Demographics
NPI:1790234060
Name:LARSON, CLAIRE CONSTANTINE (RN)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:CONSTANTINE
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 93RD ST
Mailing Address - Street 2:APT 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3722
Mailing Address - Country:US
Mailing Address - Phone:646-552-5864
Mailing Address - Fax:
Practice Address - Street 1:150 E 93RD ST
Practice Address - Street 2:APT 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3722
Practice Address - Country:US
Practice Address - Phone:646-552-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713973-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse