Doctor Name: | MRS. JESSICA JEAN LARSON |
NPI Number: | 1083901490 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | R32637 |
Business Practice Address: | Hwy 281 N Cando, ND - 583240688 |
Business Phone Number: | 7019684411 |
Business Fax Number: | |
Mailing Address: | 145 Main St E # 232, LEEDS |
State: | ND |
Postal Code: | 583467155 |
Phone Number: | 7017394228 |
Fax Number: | |
NPI Enumeration Date: | 07/06/2011 |
NPI Last Update Date: | 07/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R32637 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |