Doctor Name: | ALECIA LEE LARSEN |
NPI Number: | 1144474917 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 1221 |
Business Practice Address: | 3931 Louisiana Ave S Ste E400 Saint Louis Park, MN - 554265000 |
Business Phone Number: | 9529933230 |
Business Fax Number: | 9529931748 |
Mailing Address: | 8170 33rd Ave S, Po Box 1309 Mail Stop 21110q MINNEAPOLIS |
State: | MN |
Postal Code: | 554254516 |
Phone Number: | 9529933230 |
Fax Number: | |
NPI Enumeration Date: | 11/06/2008 |
NPI Last Update Date: | 03/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 1221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |