Individual
MR. SUSAN ANN O'MALLEY-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
2075 LOWER RIDGE RD, PORT WASHINGTON, WI 53074-9674
(262) 284-0389
Mailing address
2075 LOWER RIDGE RD, PORT WASHINGTON, WI 53074-9674
(262) 284-0389
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309598-031
WI
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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