Healthcare Provider Details

I. General information

NPI: 1801865514
Provider Name (Legal Business Name): JEANETTE PUESCHEL LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE KAREN PUESCHEL MD

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE STE 202
NORFOLK VA
23510-1065
US

IV. Provider business mailing address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-9015
  • Fax: 757-510-9041
Mailing address:
  • Phone: 825-326-3000
  • Fax: 828-326-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101270991
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number27215
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number200701520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: