Provider Demographics
NPI:1952654386
Name:LARSEN, ASHLEY MARIE-FREW (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE-FREW
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:FREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2542
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-2542
Mailing Address - Country:US
Mailing Address - Phone:626-353-2823
Mailing Address - Fax:
Practice Address - Street 1:1975 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3018
Practice Address - Country:US
Practice Address - Phone:818-249-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant