Healthcare Provider Details

I. General information

NPI: 1568471761
Provider Name (Legal Business Name): CHERYL B LARSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3822 IONA WAY SW
ALEXANDRIA MN
56308-4802
US

IV. Provider business mailing address

3822 IONA WAY SW
ALEXANDRIA MN
56308-4802
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1933
  • Fax:
Mailing address:
  • Phone: 320-762-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR0712783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: