| NPI | 1275749566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY JEAN LARSON Account Manager 920-885-3305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-04-08 |