Healthcare Provider Details

I. General information

NPI: 1851966675
Provider Name (Legal Business Name): LARUTHIEA JONES APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 W. SILVER SPRING DRIVE STE 250 PMB 1081
MILWAUKEE WI
53225
US

IV. Provider business mailing address

10400 W. SILVER SPRING 250/1081
MILWAUKEE WI
53225
US

V. Phone/Fax

Practice location:
  • Phone: 414-395-0058
  • Fax: 414-585-9272
Mailing address:
  • Phone: 414-395-0058
  • Fax: 414-585-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number154583
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13315
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: