Provider Demographics
NPI:1881760643
Name:LARSEN, PUSHPA (ND)
Entity type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:PUSHPA
Other - Middle Name:NC,
Other - Last Name:LARSEN-GIACALONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:10051 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1071
Mailing Address - Country:US
Mailing Address - Phone:206-498-1500
Mailing Address - Fax:
Practice Address - Street 1:10051 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1071
Practice Address - Country:US
Practice Address - Phone:206-498-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT000000925175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT000000925OtherWA STATE MEDICAL LICENSE