Provider Demographics
NPI:1437521655
Name:LARSON, MARION ROSE (PA)
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:ROSE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MARION
Other - Middle Name:LARSON
Other - Last Name:LUPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1222 S 72ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3009
Mailing Address - Country:US
Mailing Address - Phone:979-739-5847
Mailing Address - Fax:
Practice Address - Street 1:1222 S 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-3009
Practice Address - Country:US
Practice Address - Phone:979-739-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical