Individual
LARISSA A MUSGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
401 3RD ST SE, JAMESTOWN, ND 58401-4247
(701) 253-5300
(701) 253-5402
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 253-5300
(701) 253-5402
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
626
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54497
—
ND
01
—
6300192
MEDICA #
ND
01
—
6300193
MEDICA
ND
01
—
HP38430
HEALTHPARTNERS #
ND
01
—
P00054456
RR MEDICARE#
ND
Enumeration date
05/23/2006
Last updated
07/18/2012
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