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NPI Code Detail

MEDICARE: LARISSA NELSON

MEDICARE: LARISSA NELSON
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
1207V00000XObstetrics & Gynecology Physician45464MN

General Provider Information

NPI Number : 1861479875
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISSA NELSON
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-863-4000
Fax Number : 612-863-3809
Provider Business Practice Location Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-863-4000
Fax Number : 612-863-3809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 06/09/2026

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Directions to “ LARISSA NELSON ” Practice Location

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