MEDICARE: BRYANNA LARSON SNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0102X	Maternal Newborn Registered Nurse	20124430	WI

General Provider Information

NPI Number	:	1952260416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANNA LARSON SNM

Provider Business Mailing Address
First Line	:	12801 COUNTY HWY S
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-6250
Country	:	US
Telephone Number	:	715-223-9130
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 COUNTY HWY S
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-6250
Country	:	US
Telephone Number	:	715-223-9130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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