| NPI | 1447358577 |
|---|---|
| Former Name | JENNIFER MARIE LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024166930) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001182432) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-04-27 |