Healthcare Provider Details

I. General information

NPI: 1255143400
Provider Name (Legal Business Name): ABBY LARSON CNP,PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 37TH ST STE 5
HIBBING MN
55746-2972
US

IV. Provider business mailing address

34758 W DEER LAKE RD
DEER RIVER MN
56636-3119
US

V. Phone/Fax

Practice location:
  • Phone: 218-209-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12486
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: