Healthcare Provider Details

I. General information

NPI: 1922413368
Provider Name (Legal Business Name): JAMI LYNN LARSON RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 ABBEY RD
PIERRE SD
57501-7805
US

IV. Provider business mailing address

1714 ABBEY RD
PIERRE SD
57501-7805
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-8841
  • Fax: 605-224-6852
Mailing address:
  • Phone: 605-224-8841
  • Fax: 605-224-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR038055
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: