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NPI Code Detail

MEDICARE: JUDITH ANN LARK APNP

MEDICARE: JUDITH ANN LARK APNP
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
1364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist5365-33WI

General Provider Information

NPI Number : 1902239940
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH ANN LARK APNP
Provider Business Mailing Address
First Line : W180N8085 TOWN HALL RD
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-3518
Country : US
Telephone Number : 262-255-7172
Fax Number :
Provider Business Practice Location Address
First Line : W180N8085 TOWN HALL RD
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-3518
Country : US
Telephone Number : 262-251-1005
Fax Number : 262-257-2570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2013
Last Update Date : 03/23/2026

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