Provider Demographics
NPI:1952539231
Name:LARSON, SHELLY ANN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ANN MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-4192
Mailing Address - Fax:724-482-4859
Practice Address - Street 1:104 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-482-4192
Practice Address - Fax:724-482-4859
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006152213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery