Individual
LAURIE DENISE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3121 S MARYLAND PKWY, STE 420, LAS VEGAS, NV 89109-2307
(702) 796-8669
(702) 796-9517
Mailing address
3131 LA CANADA ST, STE 217, LAS VEGAS, NV 89169-2578
(702) 796-8669
(702) 796-9517
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
7216
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-19282
—
NV
01
—
483864
MEDICAID ARIZONA
AZ
Enumeration date
08/10/2005
Last updated
07/25/2013
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