Individual
NICOLE M LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
G.N.P.
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3123
Mailing address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3123
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R 159786-8
MN
Other
Enumeration date
07/08/2008
Last updated
10/27/2016
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