Provider Demographics
NPI:1184296147
Name:DEROCHER LARSEN, KIM MARGARET (RRT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARGARET
Last Name:DEROCHER LARSEN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 PARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2647
Mailing Address - Country:US
Mailing Address - Phone:702-499-6478
Mailing Address - Fax:
Practice Address - Street 1:4340 PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2647
Practice Address - Country:US
Practice Address - Phone:702-499-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC15622279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care