Individual
MISS MALLORY CHRISTINE LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5330 E STOP 11 RD, INDIANAPOLIS, IN 46237-6345
(317) 893-1900
(317) 893-1901
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10002066A
IN
363AM0700X
Medical Physician Assistant
—
IN
Other
Enumeration date
06/07/2016
Last updated
05/23/2023
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