Provider Demographics
NPI:1164481016
Name:LARSON, MARTHA L (RN, ANP-C-)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN, ANP-C-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WILLIAM WHITE CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4120
Mailing Address - Country:US
Mailing Address - Phone:919-933-0362
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6853
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC081889363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health