Healthcare Provider Details

I. General information

NPI: 1205055134
Provider Name (Legal Business Name): SARAH ANN LARSON L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CLEVELAND AVE S
SAINT PAUL MN
55116-1345
US

IV. Provider business mailing address

5309 40TH AVE S
MINNEAPOLIS MN
55417-2225
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-8610
  • Fax: 651-699-1207
Mailing address:
  • Phone: 952-994-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1390
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: