Doctor Name: | TRACY L LARSON |
NPI Number: | 1033551569 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R32045 |
Business Practice Address: | 314 Ohmer St Bottineau, ND - 583181059 |
Business Phone Number: | 7012289400 |
Business Fax Number: | 7012289398 |
Mailing Address: | 414 5th St S, WILLOW CITY |
State: | ND |
Postal Code: | 583844218 |
Phone Number: | 7013664688 |
Fax Number: | |
NPI Enumeration Date: | 07/25/2013 |
NPI Last Update Date: | 07/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R32045 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |