Individual
SAMANTHA LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4387
Mailing address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4387
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA061424
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14622551
CAQH
—
Enumeration date
02/06/2020
Last updated
12/13/2023
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