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General NPI Number Information
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NPI Number | 1710381298
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Entity Type | Individual
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Provider Name | CHRISTINE LARSON RN, GCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 69 EXCHANGE ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1004
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Country | US
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Telephone | 651-232-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 7111 JOPLIN AVE S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3609
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Country | US
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Telephone | 651-246-2692
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | R143886-2
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License Number State | MN
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