Individual
JENNINE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2400 PINE RIDGE BLVD, WAUSAU, WI 54401-7803
(715) 847-2022
Mailing address
2400 PINE RIDGE BLVD, WAUSAU, WI 54401-7803
(715) 847-2022
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
51726
WI
2086S0127X
Trauma Surgery Physician
51726
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35352800
—
WI
Enumeration date
05/03/2007
Last updated
01/04/2021
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