Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 43587 | IA |
N | 207X00000X | Orthopaedic Surgeon | 65700 | WI |
N | 207X00000X | Orthopaedic Surgeon | MD60482537 | WA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD60482537 | WA |
NPI | 1336464544 |
---|---|
Provider Name | Dr. Amanda Celest Roof Larson |
First Address | Tacoma, WA 98405-4234 |
Second Address | Tacoma, WA 98405-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 27/02/2019 |