Individual
ANDREA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 ALLEN ST, RUTLAND, VT 05701-4560
(802) 775-7111
(802) 747-6260
Mailing address
1047 MAIN ST, WEST RUTLAND, VT 05777-9526
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055-0030490
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN0503
—
VT
Enumeration date
12/12/2006
Last updated
07/08/2007
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