Provider Demographics
NPI:1295858249
Name:LARSON, MARSHA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18706 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93620-9712
Mailing Address - Country:US
Mailing Address - Phone:209-769-1493
Mailing Address - Fax:
Practice Address - Street 1:40 G. ST
Practice Address - Street 2:B
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3320
Practice Address - Country:US
Practice Address - Phone:209-710-6100
Practice Address - Fax:209-827-2009
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN336299163WP0808X
CA19269363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health