Individual
MRS. KIMBERLY RAE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LN
Contact information
Practice address
120 N 19TH AVE STE D, BOZEMAN, MT 59718-3920
(406) 522-4601
(406) 522-4656
Mailing address
120 N 19TH AVE STE D, BOZEMAN, MT 59718-3920
(406) 522-4601
(406) 522-4656
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
500
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500
LICENSED NUTRITIONIST
MT
Enumeration date
11/20/2006
Last updated
07/08/2007
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