Provider Demographics
NPI:1073501433
Name:LARSON, HEIDI NOEL (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:NOEL
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4950
Mailing Address - Country:US
Mailing Address - Phone:909-982-5111
Mailing Address - Fax:909-483-0760
Practice Address - Street 1:525 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4950
Practice Address - Country:US
Practice Address - Phone:909-982-5111
Practice Address - Fax:909-483-0760
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily