Provider Demographics
NPI:1437581121
Name:LARSEN, MICHELLE R (DVM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:LARSEN
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14429 S 41ST PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6147
Mailing Address - Country:US
Mailing Address - Phone:703-281-0765
Mailing Address - Fax:
Practice Address - Street 1:14429 S 41ST PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6147
Practice Address - Country:US
Practice Address - Phone:703-281-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6166174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian