Individual
AMANDA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
420 12TH ST SE, APT 16, LE MARS, IA 51031-2800
(712) 541-1401
Mailing address
420 12TH ST SE, APT 16, LE MARS, IA 51031-2800
(712) 541-1401
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C107295
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107295
IOWA BOARD OF NURSING
IA
Enumeration date
03/23/2015
Last updated
06/25/2015
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