Provider Demographics
NPI:1740566223
Name:LARSON, CHRISTINE M (APNP FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:LARSON
Suffix:
Gender:F
Credentials:APNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12168 W VIRGINIA CIR
Mailing Address - Street 2:UNIT 7
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2051
Mailing Address - Country:US
Mailing Address - Phone:414-378-9895
Mailing Address - Fax:
Practice Address - Street 1:10701 W RESEARCH DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3452
Practice Address - Country:US
Practice Address - Phone:262-345-5343
Practice Address - Fax:262-438-1327
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4607-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2011006035OtherANCC CERTIFICATION FNP