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Individual

JANET A LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYNP, PHD, FNP

Contact information

Practice address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 768-4011
(218) 768-4814
Mailing address
200 BUNKER HILL DR, AITKIN, MN 56431-1865
(218) 927-2157
(218) 927-4130

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R133861-6
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R133861-6
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1659349934
MN
01
500001764
MEDICARE WPS - MCGREGOR
MN
01
500001766
MEDICARE WPS - AITKIN CLI
MN
01
500001767
MEDICARE WPS - HOSPITAL
MN
01
500003868
MEDICARE WPS
MN
05
632607200
MN
Enumeration date
03/10/2006
Last updated
09/17/2019
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