MEDICARE: MARY E. LARSON NP

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	RN127954	AZ

General Provider Information

NPI Number	:	1225189608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E. LARSON NP

Provider Business Mailing Address
First Line	:	10277 N 92ND ST
Second Line	:	SUITE 101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4564
Country	:	US
Telephone Number	:	480-609-1444
Fax Number	:	480-609-1359

Provider Business Practice Location Address
First Line	:	10277 N 92ND ST
Second Line	:	SUITE 101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4564
Country	:	US
Telephone Number	:	480-609-1444
Fax Number	:	480-609-1359

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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