Individual
MEGAN A LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 355-5457
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085005847
IL
363A00000X
Physician Assistant
Primary
10001552
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017042
—
IN
Enumeration date
07/23/2013
Last updated
06/23/2021
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