Individual
LARISSA M ACKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE, AMES, IA 50011
(515) 294-5801
(515) 294-1190
Mailing address
ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE, AMES, IA 50011-0001
(515) 294-5801
(515) 294-1190
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04259
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04259
IA LICENSE
IA
Enumeration date
10/12/2009
Last updated
07/27/2018
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