Provider Information for 1518416502
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DANIELLE LARSON
Sex: Female
NPI: 1518416502
Last Updated: 2016-10-01
Certification Date:
Certification Date:
Details
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NPI | 1518416502 | ||||||||
Enumeration Date | 2016-10-01 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 1111 PRAIRIE PKWY WEST FARGO, ND 58078-3132 United States Phone: 701-532-0754 | Fax: | ||||||||
Primary Practice Address | 1111 PRAIRIE PKWY WEST FARGO, ND 58078-3132 United States Phone: 701-532-0754 | Fax: | ||||||||
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