Larson, Lisa Carol

Larson, Lisa Carol is an individual health care provider with primary practice located at 822 Yellow Brick Rd , Chaska MN 55318-2152. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Larson, Lisa Carol can be contacted via phone (952) 448-3303.

Contact Information

Primary practice address
822 Yellow Brick Rd Chaska MN 55318-2152
Phone: (952) 448-3303
Fax: (952) 448-4409
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 9622 Minnesota

Profile Details

NPI number 1417945940
LBN Legal business name Larson, Lisa Carol
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417945940 NPPES
Minnesota MEDICAID 414338800

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