Provider Demographics
NPI:1740877190
Name:LARSON, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E BOULEVARD AVE DEPT 325
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58505-0602
Mailing Address - Country:US
Mailing Address - Phone:701-952-6817
Mailing Address - Fax:
Practice Address - Street 1:600 E BOULEVARD AVE DEPT 325
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58505-0602
Practice Address - Country:US
Practice Address - Phone:701-952-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant