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Individual

JENNIFER LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
3624 BROOKS ST STE 101, MISSOULA, MT 59801-7338
(888) 227-3312
Mailing address
3624 BROOKS ST STE 101, MISSOULA, MT 59801-7338
(888) 227-3312

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
6338
MT
363L00000X
Nurse Practitioner
Primary
100183
MT
363LF0000X
Family Nurse Practitioner
AP61059800
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000374300
BLUE CROSS BLUE SHIELD
MT
05
4303788
MT
Enumeration date
05/13/2006
Last updated
06/23/2021
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