Healthcare Provider Details

I. General information

NPI: 1902248875
Provider Name (Legal Business Name): JENNIFER LARSON DNP, CNM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY LARSON DNP, CNM, CPM

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13220 S 154TH ST
GILBERT AZ
85296-4400
US

IV. Provider business mailing address

13220 S 154TH ST
GILBERT AZ
85296-4400
US

V. Phone/Fax

Practice location:
  • Phone: 480-277-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM197
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number253938
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number253938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: