| NPI | 1700269008 |
|---|---|
| Former Name | LARISA JEAN NORDSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 62541) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-10336) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2020-08-14 |