Provider Demographics
NPI:1053900787
Name:LARIMER, NANCY MARIE (BS)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:LARIMER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HANSEN
Mailing Address - State:ID
Mailing Address - Zip Code:83334-5252
Mailing Address - Country:US
Mailing Address - Phone:707-695-0449
Mailing Address - Fax:
Practice Address - Street 1:2484 ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:HANSEN
Practice Address - State:ID
Practice Address - Zip Code:83334-5252
Practice Address - Country:US
Practice Address - Phone:707-695-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician