Individual
KYLE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1028 BERRY AVE APT 202, TOMAH, WI 54660-3403
(931) 561-0580
Mailing address
1028 BERRY AVE APT 202, TOMAH, WI 54660-3403
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201824-30
WA
163WP2201X
Ambulatory Care Registered Nurse
Primary
201824-30
WI
Other
Enumeration date
11/05/2014
Last updated
04/20/2026
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