Provider Demographics
NPI:1124016563
Name:AAS-LARSON, CHRISTINE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:AAS-LARSON
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EAST 3RD STREET
Mailing Address - Street 2:MSS 6AV-1
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR142441-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN054650100Medicaid
WI36019900Medicaid
MN500004088Medicare PIN