Individual
MRS. SAMANTHA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
715 S 8TH ST, MINNEAPOLIS, MN 55404-1210
(612) 873-0000
Mailing address
12110 73RD ST NE, OTSEGO, MN 55330-5061
(763) 218-7561
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
6633
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2019
Last updated
06/14/2019
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