Individual
KAITLIN MICHELE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1012 E 2ND ST, DULUTH, MN 55805-2200
(218) 249-2450
(218) 249-2451
Mailing address
1012 E 2ND ST, DULUTH, MN 55805-2200
(218) 249-2450
(218) 249-2451
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10964
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10964
MN LICENSE
MN
Enumeration date
08/09/2011
Last updated
12/18/2020
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