Provider Demographics
NPI:1033197595
Name:NILSSON, LARRY (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:NILSSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-456-7000
Mailing Address - Fax:952-944-0460
Practice Address - Street 1:4010 WEST 65TH STREET
Practice Address - Street 2:TWIN CITIES ORTHOPEDICS
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4800
Practice Address - Country:US
Practice Address - Phone:952-944-2519
Practice Address - Fax:952-944-0460
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant