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NPI Code Detail

MEDICARE: LAUREN RYLEY LARSON PA-C

MEDICARE: LAUREN RYLEY LARSON PA-C
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
1363A00000XPhysician Assistant129848MT

General Provider Information

NPI Number : 1679353122
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN RYLEY LARSON PA-C
Provider Business Mailing Address
First Line : 1545 LAKERS WAY APT 2
Second Line :
City : BILLINGS
State : MT
Zip : 59106-8556
Country : US
Telephone Number : 406-850-9193
Fax Number :
Provider Business Practice Location Address
First Line : 602 HENRY CHAPPLE ST
Second Line :
City : BILLINGS
State : MT
Zip : 59106-1874
Country : US
Telephone Number : 406-901-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 11/20/2023

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Directions to “ LAUREN RYLEY LARSON PA-C” Practice Location

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