Individual
AMY S LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
834 N SEMINARY ST, SUITE 304, GALESBURG, IL 61401-2852
(309) 342-2144
(309) 342-5104
Mailing address
834 N SEMINARY ST, SUITE 304, GALESBURG, IL 61401-2852
(309) 342-2144
(309) 342-5104
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036106772
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106772
—
IL
01
—
11053882
CAQH
—
01
—
364271985-28
JOHN DEERE
—
01
—
4815127
BC/BS
—
01
—
7860434
AETNA
—
Enumeration date
09/26/2006
Last updated
02/17/2012
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