Individual
MRS. LISA CAROL LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
822 YELLOW BRICK RD, CHASKA, MN 55318-2152
(952) 448-3303
(952) 448-4409
Mailing address
822 YELLOW BRICK RD, CHASKA, MN 55318-2152
(952) 448-3303
(952) 448-4409
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9622
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
414338800
—
MN
Enumeration date
10/10/2005
Last updated
07/08/2007
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