Individual
JENNIFER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1026 7TH ST W, SAINT PAUL, MN 55102-3828
(651) 241-1000
(651) 241-1030
Mailing address
1026 7TH ST W, SAINT PAUL, MN 55102-3828
(651) 241-1000
(651) 241-1030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11136
MN
363A00000X
Physician Assistant
PA05991
TX
363AS0400X
Surgical Physician Assistant
085003026
IL
363AS0400X
Surgical Physician Assistant
PA05991
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184809907
BLUE CROSS BLUE SHIELD
TX
05
—
206313301
—
TX
05
—
206313302
—
TX
01
—
8DC697
BLUE CROSS BLUE SHIELD
TX
01
—
8Y5543
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/31/2007
Last updated
03/05/2021
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