Individual
BETTY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2874
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
(701) 364-8078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10749
MN
363A00000X
Physician Assistant
TC
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679894299
—
MN
Enumeration date
06/17/2010
Last updated
07/24/2012
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