Provider Demographics
NPI:1487021358
Name:LARSEN, HEATHER A (AGNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:LARSEN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3789
Mailing Address - Country:US
Mailing Address - Phone:252-551-3000
Mailing Address - Fax:
Practice Address - Street 1:2210 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3789
Practice Address - Country:US
Practice Address - Phone:252-551-3000
Practice Address - Fax:252-551-3100
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264413363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health