Provider Demographics
NPI:1922413368
Name:LARSON, JAMI LYNN (RN, CDE)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LYNN
Last Name:LARSON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-7805
Mailing Address - Country:US
Mailing Address - Phone:605-224-8841
Mailing Address - Fax:605-224-6852
Practice Address - Street 1:1714 ABBEY RD
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-7805
Practice Address - Country:US
Practice Address - Phone:605-224-8841
Practice Address - Fax:605-224-6852
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR038055163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350180Medicaid