Individual
AMANDA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226
(414) 266-6943
(414) 266-2926
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-6943
(414) 266-2926
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
9077-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154887453
—
WI
Enumeration date
02/12/2019
Last updated
03/05/2019
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