Individual
ANDREA LOIS LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
800 KENYON RD, FORT DODGE, IA 50501-5776
(515) 574-6840
(515) 576-7726
Mailing address
PO BOX 9170, DES MOINES, IA 50306-9170
(515) 574-6840
(515) 576-7726
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A128100
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A128100
STATE IDENTIFICATION NUMBER
IA
Enumeration date
08/28/2016
Last updated
11/21/2016
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