Individual
BREANNE L LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
720 N BOND ST, SPRINGFIELD, IL 62702-4952
(217) 545-8000
(217) 545-0253
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(217) 545-2101
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
277.002925
IL
363LF0000X
Family Nurse Practitioner
209020940
IL
363LF0000X
Family Nurse Practitioner
Primary
277.002925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209020940
APN
IL
Enumeration date
11/02/2020
Last updated
02/12/2024
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