Larson, Jennine
Larson, Jennine is an individual health care provider with primary practice located at 2400 Pine Ridge Blvd , Wausau WI 54401-7803. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Trauma Surgery, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is her primary health care specialty. Larson, Jennine can be contacted via phone (715) 847-2022.Contact Information
Primary practice address
2400 Pine Ridge Blvd
Wausau WI 54401-7803
Phone: (715) 847-2022
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | 51726 | Wisconsin |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 51726 | Wisconsin |
Profile Details
| NPI number | 1942412044 |
|---|---|
| LBN Legal business name | Larson, Jennine |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 3rd, 2007 |
| Last updated | Jan 4th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942412044 | NPPES |
| Wisconsin | MEDICAID | 35352800 |
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