Active NPI
Nicole Marie Larsen, L.AC, M.OM
- Acupuncturist
- Bloomington, MN
National Provider Identifier
1003022179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 1378
- Practice address
- 200 W 96TH St Apt 2B
Bloomington, MN 55420-4328 - Phone
- (651) 214-1428
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1378 | MN | Primary |
Addresses
Primary practice location
200 W 96TH St Apt 2B
Bloomington, MN 55420-4328
Mailing address
200 West 96TH
Apt #2B
Bloomington, MN 55420-5542
Phone (651) 214-1428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1378 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003022179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WEST 96TH",
"address_2": "APT #2B",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554205542",
"telephone_number": "651-214-1428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W 96TH ST APT 2B",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554204328",
"telephone_number": "651-214-1428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "L.AC, M.OM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "MN",
"license": "1378",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.