Provider Demographics
NPI:1366822587
Name:LARSON, ANDREA ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:LARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-552-2600
Mailing Address - Fax:651-552-2614
Practice Address - Street 1:5625 CENEX DR
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077
Practice Address - Country:US
Practice Address - Phone:651-552-2600
Practice Address - Fax:651-552-2614
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2022008365207Q00000X
MN60805208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice