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General NPI Number Information
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NPI Number | 1235737529
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Entity Type | Individual
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Provider Name | MICHAL A LARSON RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 3724 JEFFERSON ST STE 104
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City | AUSTIN
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State | TX
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Zip | 78731-6204
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Country | US
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Telephone | 512-693-7045
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Fax |
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Provider Business Mailing Address
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Address Line | 4 DELLA ST
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City | ITHACA
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State | NY
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Zip | 14850-9034
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Country | US
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Telephone | 267-261-5586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86090887
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License Number State | PA
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