Individual
JILL C. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
240 MAPLE AVE., PROHEALTH CARE MEDICAL ASSOCIATES, INC., MUKWONAGO, WI 53149-8475
(262) 928-1900
(262) 928-1949
Mailing address
N17 W24100 RIVERWOOD DR., PROHEALTH CARE MEDICAL ASSOCIATES, INC., WAUKESHA, WI 53188-1177
(262) 928-4100
(262) 928-5835
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49669-021
WI
Other
Enumeration date
10/12/2006
Last updated
11/09/2011
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