Individual
JESSICA LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
290 MAIN ST NW, ELK RIVER, MN 55330-1270
(763) 241-5800
Mailing address
27060 136TH ST, ZIMMERMAN, MN 55398-9300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
46376
MN
Other
Enumeration date
06/12/2006
Last updated
07/08/2007
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