Healthcare Provider Details

I. General information

NPI: 1124016563
Provider Name (Legal Business Name): CHRISTINE AAS-LARSON RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LONDON ROAD SUITE 102
DULUTH MN
55812
US

IV. Provider business mailing address

400 EAST 3RD STREET MSS 6AV-1
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-576-0100
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR142441-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: