Individual
EMILY JACKSON LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18301 N 79TH AVE STE F168, GLENDALE, AZ 85308-6045
(623) 544-9090
Mailing address
10946 N 153RD LN, SURPRISE, AZ 85379-5325
(801) 808-3256
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
313215
AZ
Other
Enumeration date
07/01/2024
Last updated
05/26/2025
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