Nicole Larsen, RN

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

2279664 Issued in MN

Practice address

24760 Hospital Dr
Red Lake, MN 56671

Phone

(218) 679-0112

Fax

(218) 679-0187

NPI assigned

Dec 16, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1639986334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 497",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "566710497",
            "telephone_number": "218-679-0112",
            "fax_number": "218-679-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24760 HOSPITAL DR",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-0112",
            "fax_number": "218-679-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "NICOLE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "2279664",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MN",
            "license": "2279664",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "MN",
            "license": "2279664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Ryan Kelly, MSN, APRN, PMHNP-BC
• Andrew S Kingbird, CHW, CASE MANAGER
• Keveon K Kingbird, CHW
• Rachel Koch, NURSE PRACTITIONER
• Anthony John Ladner, PHARMD.
• Thomas Powell Luft, D.O.
• Mary E Mackey, PHARMD
• Kathleen Marmorine
• Tasha M Martell, CHW
• Vivianna Raylene Martin, PHARMD, MBA

• All providers in Red Lake, MN
• Case Management Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.