Most Relevant Information
Provider Data
| NPI Number: | 1003022179 |
| Provider Name: | NICOLE MARIE LARSEN L.AC, M.OM |
| Entity Type: | Individual |
| Taxonomy Code: | 171100000X |
| Specialty: | Acupuncturist |
| License Number: | 1378 |
Most Important Dates
| Enumeration Date: | 05/15/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
200 W 96TH ST APT 2B
BLOOMINGTON
MN
554204328
Practice Location Phone/Fax
| Phone: | 6512141428 |
| Fax: |
Provider Mailing Location
200 WEST 96TH
APT #2B
BLOOMINGTON
MN
554205542
Provider Mailing Phone/Fax
| Phone: | 6512141428 |
| Fax: |