Most Relevant Information
Provider Data
| NPI Number: | 1003249269 |
| Provider Name: | HEATHER MARIE LARSON PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 016812-1 |
Most Important Dates
| Enumeration Date: | 08/12/2013 |
| Last Updated: | 08/12/2013 |
Provider Practice Location
3065 SOUTHWESTERN BLVD
SUITE 100
ORCHARD PARK
NY
141271239
Practice Location Phone/Fax
| Phone: | 7166779220 |
| Fax: | 7166779226 |
Provider Mailing Location
3065 SOUTHWESTERN BLVD
SUITE 100
ORCHARD PARK
NY
141271239
Provider Mailing Phone/Fax
| Phone: | 7166779220 |
| Fax: | 7166779226 |