Individual
ANN R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
701 N 1ST ST, ANESTHESIA DEPARTMENT, SPRINGFIELD, IL 62781-0001
(217) 788-3754
(217) 788-7071
Mailing address
701 N 1ST ST, ANESTHESIA DEPARTMENT, SPRINGFIELD, IL 62781-0001
(217) 788-3754
(217) 788-7071
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209008036
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082677
CCNA CERTIFICTION
IL
Enumeration date
02/04/2010
Last updated
03/10/2010
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