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NPI Code Detail

MEDICARE: DR. KATELYN CLAIRE LARSON MD

MEDICARE: DR. KATELYN CLAIRE LARSON MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1225727779
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATELYN CLAIRE LARSON MD
Provider Business Mailing Address
First Line : 15404 92ND PL NE
Second Line :
City : BOTHELL
State : WA
Zip : 98011-4555
Country : US
Telephone Number : 425-417-6837
Fax Number :
Provider Business Practice Location Address
First Line : 150 55TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-2508
Country : US
Telephone Number : 718-630-8381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2023
Last Update Date : 05/02/2023

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