Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD053692L | PA |
Y | 207V00000X | Obstetrician & Gynecologist | N5181 | TX |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | N5181 | TX |
NPI | 1861478364 |
---|---|
Provider Name | Dr. Wilma I. Larsen |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 12/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | HI |