Provider Demographics
NPI:1518591510
Name:LARSON, LAURA (DNP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 E ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6869
Mailing Address - Country:US
Mailing Address - Phone:928-243-4580
Mailing Address - Fax:
Practice Address - Street 1:1929 W FILLMORE ST BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3812
Practice Address - Country:US
Practice Address - Phone:928-243-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230926363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care