Individual
MRS. JILL KATHERINE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 546-4400
Mailing address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 546-4400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9975
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-20459
MEDICA ONAMIA CLINIC
MN
01
—
01-20460
MEDICA HILLMAN CLINIC
MN
01
—
01-20461
MEDICA ISLE CLINIC
MN
01
—
132635
UCARE
MN
01
—
430L3LA
BLUE CROSS CLINICS
MN
05
—
911435100
—
MN
01
—
HP50104
HEALTH PARTNERS
MN
01
—
NA9091043681
PREFERRED ONE
MN
Enumeration date
05/19/2006
Last updated
11/19/2020
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