Individual
MR. JEFFREY R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
201 STATE ST, ERIE, PA 16550-0002
(814) 877-6139
(814) 877-6093
Mailing address
717 STATE ST, SUITE 16, LL, ERIE, PA 16501-1341
(814) 877-7100
(814) 877-2939
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP007048
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02799186
NY MEDICAL ASSISTANC
NY
01
—
3000584
WEST VIRGINIA WORK COMP
WV
Enumeration date
01/20/2006
Last updated
05/23/2012
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