Provider Demographics
NPI:1932777067
Name:LARKIN, ALYSON DAWN (CD, THW)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:DAWN
Last Name:LARKIN
Suffix:
Gender:F
Credentials:CD, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17506 SW MASONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8564
Mailing Address - Country:US
Mailing Address - Phone:503-975-2324
Mailing Address - Fax:
Practice Address - Street 1:17506 SW MASONVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8564
Practice Address - Country:US
Practice Address - Phone:503-975-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104582374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
THW000104582OtherTRADITIONAL HEALTH WORKER (THW) REGISTRY NUMBER