Individual
TARA R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
(701) 364-8078
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
AA113010
ME
367500000X
Certified Registered Nurse Anesthetist
Primary
R37536
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16895
—
ND
Enumeration date
04/12/2011
Last updated
07/26/2012
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