Individual
ANDREA LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 COLLEGE PKWY, BUFFALO, NY 14221-6800
(716) 626-0093
Mailing address
4360 RUSHFORD DR, HAMBURG, NY 14075-3081
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022121
NY
Other
Enumeration date
04/19/2018
Last updated
11/08/2021
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