| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LARS LARSON | 1427652361 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Lars Larson CRNP |
| Practice Office Address | 701 PRINCETON AVE SW BIRMINGHAM, AL US |
| Practice Office Telephone | 2057837970 |
| Mailing Address | 1141 N SHADESVIEW TER HOMEWOOD, AL 352096637 US |
| Code | License No | State |
|---|---|---|
| 363LA2100X PRIMARY | 1-153397 | AL |