Individual
JEANNIE THERESE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9555 UPLAND LANE N, MAPLE GROVE, MN 55369
(952) 993-3260
Mailing address
8170 33RD AVE S, P.O. BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
(952) 993-3260
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
33568
MN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
33568
MN
Other
Enumeration date
12/01/2005
Last updated
08/14/2020
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