Individual
MRS. JAMIE P LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2530 E SOUTHERN AVE, MESA, AZ 85204-5411
(480) 834-4188
Mailing address
25 CROSSROADS DR STE 306, OWINGS MILLS, MD 21117-5437
(602) 222-1900
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
57597411206
UT
363AM0700X
Medical Physician Assistant
Primary
5177
AZ
363AM0700X
Medical Physician Assistant
57597411206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005752
—
AZ
05
—
553068427005
—
UT
Enumeration date
02/05/2007
Last updated
05/20/2024
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