MEDICARE: CHRISTINE AAS-LARSON RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R142441-0	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124016563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE AAS-LARSON RN, CNP

Provider Business Mailing Address
First Line	:	400 EAST 3RD STREET
Second Line	:	MSS 6AV-1
City	:	DULUTH
State	:	MN
Zip	:	55805-1951
Country	:	US
Telephone Number	:	218-786-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 LONDON ROAD
Second Line	:	SUITE 102
City	:	DULUTH
State	:	MN
Zip	:	55812
Country	:	US
Telephone Number	:	218-576-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	12/03/2019

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