Individual
AYN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1810 S CRISMON RD STE 191, MESA, AZ 85209-3900
(480) 393-0575
(480) 704-4019
Mailing address
1810 S CRISMON RD STE 191, MESA, AZ 85209-3900
(480) 393-0575
(480) 704-4019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4314
CO
363A00000X
Physician Assistant
Primary
6473
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78820057
—
CO
Enumeration date
08/20/2015
Last updated
12/22/2016
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