Provider Demographics
NPI:1942751797
Name:LARSEN, KATIE JO (FNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:LARSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHFIELD HOSPITAL
Mailing Address - Street 2:2000 NORTH AVE
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-646-1000
Mailing Address - Fax:
Practice Address - Street 1:NORTHFIELD HOSPITAL & CLINICS - URGENT CARE LAKEVILLE
Practice Address - Street 2:9974 214TH ST W
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55054
Practice Address - Country:US
Practice Address - Phone:952-469-0500
Practice Address - Fax:950-469-0505
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005064363LF0000X
MNR1623486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily