Individual
JOHN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 5TH ST NW UNIT 790, WATFORD CITY, ND 58854-7118
(701) 444-3661
(701) 444-6436
Mailing address
201 5TH ST NW UNIT 790, WATFORD CITY, ND 58854-7118
(701) 444-3661
(701) 444-6436
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
937374
—
ND
Enumeration date
06/17/2020
Last updated
06/17/2020
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