Individual
MRS. LESLEY RAE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NMW
Contact information
Practice address
81 MEDICAL VILLAGE DR, SUITE 2, NEWPORT, VT 05855-9835
(802) 334-4110
(802) 334-4113
Mailing address
81 MEDICAL VILLAGE DR, SUITE 2, NEWPORT, VT 05855-9835
(802) 334-4110
(802) 334-4113
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
1010030803
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068564
BLUE SHIELD OF VERMONT
VT
01
—
78119
MVP
VT
01
—
8000748
LADIES FIRST
VT
Enumeration date
11/01/2006
Last updated
07/08/2007
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