| Doctor Name: | AMANDA LARSON |
| NPI Number: | 1457745986 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-PC |
| License Number: | C107295 |
| Business Practice Address: | 420 12th St Se Apt 16 Le Mars, IA - 510312800 |
| Business Phone Number: | 7125411401 |
| Business Fax Number: | |
| Mailing Address: | 420 12th St Se, Apt 16 LE MARS |
| State: | IA |
| Postal Code: | 510312800 |
| Phone Number: | 7125411401 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2015 |
| NPI Last Update Date: | 06/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | C107295 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |