Individual
MICHELENE C LARRABEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3213 92ND ST, STURTEVANT, WI 53177-2705
(814) 470-1324
Mailing address
3213 92ND ST, STURTEVANT, WI 53177-2705
(814) 470-1324
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
615
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076313000
—
WV
05
—
0941413
—
OH
05
—
2719151
—
OH
05
—
3810006527
—
WV
Enumeration date
07/17/2006
Last updated
01/05/2022
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