Provider Demographics
NPI:1447577929
Name:LARSON, HOLLY ANNE (MS, RD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5176 MORNING SUN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:740-707-6101
Mailing Address - Fax:
Practice Address - Street 1:5176 MORNING SUN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056
Practice Address - Country:US
Practice Address - Phone:740-707-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85002377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered