Individual
MISS JESSICA M LARUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10417 S MOCKINGBIRD LN, OAK CREEK, WI 53154-6317
(414) 507-1586
Mailing address
10417 S MOCKINGBIRD LN, OAK CREEK, WI 53154-6317
(414) 507-1586
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
162437-30
WI
Other
Enumeration date
08/04/2012
Last updated
08/04/2012
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