MEDICARE: MS. JAMIE JOY LARSON 245D PROVIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	1130763	MN

General Provider Information

NPI Number	:	1740135821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE JOY LARSON 245D PROVIDER

Provider Business Mailing Address
First Line	:	5994 188TH ST W
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-7065
Country	:	US
Telephone Number	:	651-341-4195
Fax Number	:

Provider Business Practice Location Address
First Line	:	5994 188TH ST W
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-7065
Country	:	US
Telephone Number	:	651-341-4195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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