| Doctor Name: | CARLY NICOLE LARSON |
| NPI Number: | 1043645690 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085004730 |
| Business Practice Address: | 5435 Feltl Rd Minnetonka, MN - 553437983 |
| Business Phone Number: | 9528359880 |
| Business Fax Number: | |
| Mailing Address: | 5435 Feltl Rd, MINNETONKA |
| State: | MN |
| Postal Code: | 553437983 |
| Phone Number: | 9528359880 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2013 |
| NPI Last Update Date: | 06/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085004730 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |