Provider Demographics
NPI:1588134365
Name:LARSON, BRITTANY MELISSA (CNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MELISSA
Last Name:LARSON
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:CHARNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:702-383-7395
Practice Address - Street 1:IHA URGENT CARE
Practice Address - Street 2:4200 WHITEHALL DRIVE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-995-0308
Practice Address - Fax:702-383-7395
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704296112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22366OtherSC STATE LICENSE