Larry Nilsson

NPI 1033197595 - Physician Assistant - 363A00000X

NPI Details
NPI 1033197595
Gender Male
Enumeration Date 01/05/2006
Last Updated 06/12/2015
Entity Type Individual
Active Over 10 years ago
Practice Location
8100 NORTHLAND DR
BLOOMINGTON MN, 55431-4800, US
Phone (952) 831-8742
Fax
Business Location
6465 WAYZATA BLVD
SUITE 315
ST LOUIS PARK MN, 55426-1728, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Minnesota
License Number 9754
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According to our database, Larry Nilsson NPI is 1033197595, taxonomy code is 363A00000X and license number is 9754, license state is located at Minnesota. Larry Nilsson physically located at 8100 Northland Dr, Bloomington MN, 55431-4800. NPI Number Larry Nilsson has the Individual type.

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1033197595 NPI number is provided on an as is basis without warranty of any kind. 1033197595 is maintained by the National Plan & Provider Enumeration System. The contents of Larry Nilsson are for informational purposes only.