Individual
MITCHELL D LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1801 16TH ST, GREELEY, CO 80631-5154
(970) 352-4121
Mailing address
6527 ABERDOUR CIR, WINDSOR, CO 80550-7012
(970) 776-6991
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1378618
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
CRA-15015
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122019500
—
MN
05
—
16674847
—
CO
Enumeration date
03/14/2006
Last updated
06/23/2010
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