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General NPI Number Information
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NPI Number | 1154495828
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Entity Type | Organization
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Legal Business Name | ANGIE LARSEN MD
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | SUITE 205 395 WALLACE RD BLDG B
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City | NASHVILLE
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State | TN
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Zip | 37211-4881
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Country | US
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Telephone | 615-832-0909
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Fax | 615-832-0933
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Provider Business Mailing Address
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Address Line | SUITE 205 395 WALLACE RD BLDG B
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City | NASHVILLE
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State | TN
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Zip | 37211-4881
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Country | US
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Telephone | 615-832-0909
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Fax | 615-832-0933
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Authorized Official
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Title or Position | OWNER
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Name | ANGIE LARSEN
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Credential | MD
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Telephone | 615-832-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 30449
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License Number State | TN
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