Provider Demographics
NPI:1114025475
Name:LARSON, TRENETTE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENETTE
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6700
Mailing Address - Country:US
Mailing Address - Phone:307-637-0444
Mailing Address - Fax:307-637-0220
Practice Address - Street 1:1202 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6700
Practice Address - Country:US
Practice Address - Phone:307-637-0444
Practice Address - Fax:307-637-0220
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3624A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY309164Medicare ID - Type Unspecified
WYG03124Medicare UPIN