Provider Demographics
NPI:1083901490
Name:LARSON, JESSICA JEAN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MAIN ST E # 232
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ND
Mailing Address - Zip Code:58346-7155
Mailing Address - Country:US
Mailing Address - Phone:701-739-4228
Mailing Address - Fax:
Practice Address - Street 1:HWY 281 N
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-0688
Practice Address - Country:US
Practice Address - Phone:701-968-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily