Healthcare Provider Details

I. General information

NPI: 1588500599
Provider Name (Legal Business Name): MEGAN NICOLE LARSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

918 ELM ST
MAUSTON WI
53948-1907
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number254209-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: