Individual
LARISSA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 SAINT FRANCIS AVE, SUITE 200, SHAKOPEE, MN 55379-3374
(952) 993-7750
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
45464
MN
Other
Enumeration date
12/30/2005
Last updated
03/05/2012
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