Provider Demographics
NPI:1679963284
Name:LARSON, AMY LYNETTE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNETTE
Last Name:LARSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:203 N WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0254
Mailing Address - Country:US
Mailing Address - Phone:509-434-0359
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:338 6TH ST # 101
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2420
Practice Address - Country:US
Practice Address - Phone:208-848-8300
Practice Address - Fax:208-848-8303
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1532A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily