Provider Demographics
NPI:1518172170
Name:LARSON, RHONDA DALENE (LM CPM)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:DALENE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203
Mailing Address - Country:US
Mailing Address - Phone:480-610-8164
Mailing Address - Fax:480-649-3164
Practice Address - Street 1:1340 E GRANADA ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:480-610-8164
Practice Address - Fax:480-649-3164
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ120176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife