Individual
MIRANDA N LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 546-4400
Mailing address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 546-4400
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4587
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4587
DIETITIAN
MN
Enumeration date
03/31/2022
Last updated
03/09/2023
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