| Doctor Name: | MRS. DEANNA LARSON |
| NPI Number: | 1710324918 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN CCM CDOE |
| License Number: | RN22489 |
| Business Practice Address: | 264 Camp Dixie Rd Pascoag, RI - 028592823 |
| Business Phone Number: | 4015739210 |
| Business Fax Number: | |
| Mailing Address: | 264 Camp Dixie Rd, PASCOAG |
| State: | RI |
| Postal Code: | 028592823 |
| Phone Number: | 4015739210 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2013 |
| NPI Last Update Date: | 05/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | RN22489 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |