Individual
LAURI RENEE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
380 CHASE AVE, FAMILY PRACTICE, WALLA WALLA, WA 99362-2924
(509) 522-5822
(509) 522-5575
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00043652
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477567881
—
WA
05
—
233127
—
OR
Enumeration date
07/28/2006
Last updated
06/16/2021
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