Individual
AMY ELIZABETH LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2350 N LAKE DR, SUITE 206, MILWAUKEE, WI 53211-4528
(414) 298-7280
Mailing address
8070 HORSESHOE BEND RD, BLANCHARDVILLE, WI 53516-9147
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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