Individual
MRS. GIZELL R LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1305 W AMERICAN DR, NEENAH, WI 54956-1993
(920) 725-9373
(920) 720-7392
Mailing address
1305 W AMERICAN DR, NEENAH, WI 54956-1993
(920) 725-9373
(920) 720-7392
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
26600
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001371450
MEDICARE
WI
05
—
30625000
—
WI
Enumeration date
05/13/2006
Last updated
02/27/2012
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