Individual
BRENDA R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-5000
(952) 993-3248
Mailing address
8170 33RD AVE S, PO BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
48944
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35216700
—
WI
05
—
652600000
—
MN
05
—
ENROLLED
—
IA
01
—
P00391392
RAILROAD MEDICARE
MN
Enumeration date
08/05/2006
Last updated
04/13/2016
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