Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 322 | FL |
NPI | 1134588429 |
---|---|
Provider Name | Anna Belen Larson |
First Address | Evinston, FL 32633-0058 |
Second Address | Micanopy, FL 32667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 16/02/2016 |