Individual
MRS. KATHERINE MCCOURT ROBINSON LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
4725 36TH AVE N, CRYSTAL, MN 55422-2169
(218) 208-2058
Mailing address
820 SPRINGER DR, LOMBARD, IL 60148-6413
(815) 744-8554
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9624
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0115028
MEDICA
—
01
—
131240
UCARE
—
05
—
215598200
—
MN
Enumeration date
09/07/2005
Last updated
01/25/2022
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