Individual
MRS. HEATHER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 655-2000
Mailing address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(801) 791-4886
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
209.031767
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209031767
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/26/2025
Last updated
03/11/2025
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