Provider Demographics
NPI:1356963268
Name:LARSEN, ANNE MARIE (CNM)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 GILT EDGE STAGE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2087
Mailing Address - Country:US
Mailing Address - Phone:406-538-3925
Mailing Address - Fax:
Practice Address - Street 1:2298 GILT EDGE STAGE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2087
Practice Address - Country:US
Practice Address - Phone:406-538-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-158682176B00000X
MO2021036797176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife