Provider Demographics
NPI:1427299007
Name:LARSON, KRISTIN A (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:220 PAWTUCKET ST SUITE 300
Mailing Address - Street 2:UNIVERSITY CROSSING
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-934-6800
Mailing Address - Fax:978-934-3080
Practice Address - Street 1:220 PAWTUCKET ST SUITE 300
Practice Address - Street 2:UNIVERSITY CROSSING
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-934-6800
Practice Address - Fax:978-934-3080
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2019-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA273962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1427299007OtherBCBS MASS
MA1427299007OtherBCBS MASS