Provider Demographics
NPI:1609334200
Name:LARSON, CLAIRE O'NEILL (PA-C)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:O'NEILL
Last Name:LARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:EMILY
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13205 ISLE DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8554
Mailing Address - Country:US
Mailing Address - Phone:218-454-7600
Mailing Address - Fax:218-454-7681
Practice Address - Street 1:13205 ISLE DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8554
Practice Address - Country:US
Practice Address - Phone:218-454-7600
Practice Address - Fax:218-454-7681
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant