Individual
BRANDI LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
777 S MAIN ST STE 100, CLINTON, IN 47842-2493
(765) 828-1003
Mailing address
777 S MAIN ST STE 100, CLINTON, IN 47842-2493
(765) 828-1003
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28198009A
IN
363LF0000X
Family Nurse Practitioner
Primary
71006369A
IN
Other
Enumeration date
06/13/2016
Last updated
08/09/2016
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