Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN349585L | PA |
N | 363L00000X | Nurse Practitioner | TP004902B | PA |
N | 363LC1500X | Nurse Practitioner - Community Health | TP004902B | PA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | TP004902B | PA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | TP004902B | PA |
NPI | 1831107663 |
---|---|
Provider Name | Ms. Paula Lynn Larson |
First Address | Philadelphia, PA 19144 |
Second Address | Philadelphia, PA 19142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 29/06/2021 |