Provider Demographics
NPI:1487131579
Name:LARSON, KATHRYN RUTH (C-NP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RUTH
Last Name:LARSON
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:STE 1001
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2753
Mailing Address - Country:US
Mailing Address - Phone:978-922-2226
Mailing Address - Fax:978-922-2269
Practice Address - Street 1:414 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-1919
Practice Address - Country:US
Practice Address - Phone:877-379-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266384207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine