Healthcare Provider Details

I. General information

NPI: 1013052778
Provider Name (Legal Business Name): JEANNE MARIE LARSON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6773 SPRING COULEE RIDGE RD
WESTBY WI
54667-7117
US

IV. Provider business mailing address

E6773 SPRING COULEE RIDGE RD
WESTBY WI
54667-7117
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-3010
  • Fax:
Mailing address:
  • Phone: 608-634-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: