Provider Demographics
NPI:1396035408
Name:LARSON, SARAH MARIA (ANP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIA
Last Name:LARSON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14122 W MCDOWELL RD
Mailing Address - Street 2:STE 102-B
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2503
Mailing Address - Country:US
Mailing Address - Phone:623-236-8720
Mailing Address - Fax:623-234-9682
Practice Address - Street 1:14122 W MCDOWELL RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2503
Practice Address - Country:US
Practice Address - Phone:623-236-8720
Practice Address - Fax:623-234-9682
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4007363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health