Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 8662 | MN |
NPI | 1023771243 |
---|---|
Provider Name | Anna Ruth Larson |
First Address | Northfield, MN 55057-3430 |
Second Address | Minneapolis, MN 55454-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2021 |
Last Update Date | 14/10/2021 |