Provider Demographics
NPI:1801865514
Name:LARSON, JEANETTE PUESCHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:PUESCHEL
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANETTE
Other - Middle Name:KAREN
Other - Last Name:PUESCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:810 FAIRGROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9617
Mailing Address - Country:US
Mailing Address - Phone:825-326-3000
Mailing Address - Fax:828-326-2450
Practice Address - Street 1:301 RIVERVIEW AVE STE 202
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9015
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012709912084N0400X
AZ272152084N0400X
NC2007015202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27215OtherSTATE LICENSE
NC200701520OtherSTATE LICENSE