Healthcare Provider Details

I. General information

NPI: 1356871438
Provider Name (Legal Business Name): ELISABETH LARSON DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date: 08/15/2024
Reactivation Date: 08/20/2024

III. Provider practice location address

94 LOCUST AVE
DANBURY CT
06810-6032
US

IV. Provider business mailing address

1 KENNEDY AVE UNIT 1335
DANBURY CT
06810-5782
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number581
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: