Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 51743 | MN |
Y | 207VX0000X | Obstetrician | 53219 | AZ |
NPI | 1295937993 |
---|---|
Provider Name | Dr. Michelle Lyn Larson |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85712-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235618 | (05) | AZ |
53219 | AZ MEDICAL LICENCSE (01) | AZ |