Individual
AMY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3456
(651) 254-9673
Mailing address
PO BOX 1309, MS 21110Q, MINNEAPOLIS, MN 55440-1309
(651) 254-3456
(651) 254-9673
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46577
MN
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
46577
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-00123
MEDICA-PRIMARY
MN
01
—
0407540
MEDICA-CHOICE
MN
05
—
0591149
—
IA
01
—
1045965
PREFERRED ONE
—
01
—
132940
UCARE
MN
01
—
2368958
AMERICA'S PPO
MN
05
—
34629900
—
WI
01
—
505925
FAIRVIEW
MN
05
—
622695700
—
MN
01
—
631T3LA
BCBS
MN
01
—
9376963
PHCS
MN
01
—
B539
CHAMPUS
—
01
—
HP53301
HEALTH PARTNERS
MN
Enumeration date
10/16/2006
Last updated
03/17/2018
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