Provider Demographics
NPI:1134826654
Name:LARSON, VIVIAN (APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MCGOEY CIR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2129
Mailing Address - Country:US
Mailing Address - Phone:281-387-2165
Mailing Address - Fax:
Practice Address - Street 1:1200 BINZ ST STE 900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6938
Practice Address - Country:US
Practice Address - Phone:713-522-0220
Practice Address - Fax:713-522-0232
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110423363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care