Provider Demographics
NPI:1659349934
Name:LARSON, JANET A (PSYNP, PHD, FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:PSYNP, PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1865
Mailing Address - Country:US
Mailing Address - Phone:218-927-2157
Mailing Address - Fax:218-927-4130
Practice Address - Street 1:200 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1865
Practice Address - Country:US
Practice Address - Phone:218-768-4011
Practice Address - Fax:218-768-4814
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR133861-6363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500001766OtherMEDICARE WPS - AITKIN CLI
MN500001767OtherMEDICARE WPS - HOSPITAL
MN1659349934Medicaid
MN500001764OtherMEDICARE WPS - MCGREGOR
MN632607200Medicaid
MN500003868OtherMEDICARE WPS