Provider Demographics
NPI:1699740233
Name:LARSON, KARIN JEAN (CNM)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:JEAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:JEAN
Other - Last Name:HANGSLEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:640 JACKSON STREET
Practice Address - Street 2:MC 11503H
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-1025
Practice Address - Fax:651-254-1024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0882066367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S05833Medicare UPIN