| Doctor Name: | MRS. JILL KATHERINE LARSEN |
| NPI Number: | 1316991086 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 9975 |
| Business Practice Address: | 200 Elm St N Onamia, MN - 563597901 |
| Business Phone Number: | 3205323154 |
| Business Fax Number: | 3205323111 |
| Mailing Address: | 320 E Main St, CROSBY |
| State: | MN |
| Postal Code: | 564411645 |
| Phone Number: | 2185468375 |
| Fax Number: | 2185464400 |
| NPI Enumeration Date: | 05/19/2006 |
| NPI Last Update Date: | 08/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 9975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |