Provider Demographics
NPI:1326438235
Name:LARSON, ANNIE LAURIE (LPN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAURIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6084 HAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502-9323
Mailing Address - Country:US
Mailing Address - Phone:608-206-0333
Mailing Address - Fax:
Practice Address - Street 1:N6084 HAMMER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:WI
Practice Address - Zip Code:53502-9323
Practice Address - Country:US
Practice Address - Phone:608-206-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317927-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse