Basic Information
| Provider Information | |||||||||
| NPI: | 1841639358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | BRIELLE | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 423 OAKWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | FRUITA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815217439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702103248 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2121 NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815016428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702420731 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1620379 | CO | Y | Nursing Service Providers | Registered Nurse |
No ID Information.