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Individual

MR. NATHAN S LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
(417) 533-6021
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2013002285
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1255683777
MO
05
600420082
MO
Enumeration date
10/08/2012
Last updated
07/16/2015
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