JENNINE LARSON (NPI# 1942412044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942412044 |
| Entity Type | Individual |
| Full Name | JENNINE LARSON |
| Credential | M.D. |
| Practice Address |
2400 Pine Ridge Blvd Wausau WI 54401-7803 |
| Practice Telephone | 7158472022 |
| Mailing Telephone | 7158472022 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2016-07-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 51726 | WI | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 125-044322 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 35352800 | 05 |
| Street Address |
2400 PINE RIDGE BLVD |
| City | WAUSAU |
| State | WI |
| Zip Code | 54401-7803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558363432 | James P. Binder | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2005-08-11 |
| 1760080584 | Sabrina Pfannsmith | Specialist/Technologist, Other | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2020-10-14 |
| 1952961633 | Ellen A Humberston | Physician Assistant | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2019-06-16 |
| 1154816437 | Anthony Vincent Hull | Physician Assistant | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2018-06-28 |
| 1144733742 | Sarah Adams | Specialist/Technologist, Other | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2017-11-06 |
| 1982129888 | Suzanne Solin | Physician Assistant | 2400 Pine Ridge Blvd, Wausau, WI 54401 | 2017-08-11 |
| 1528514338 | Joan Spindler | Specialist/Technologist, Other | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2016-08-31 |
| 1083160865 | Linda Blume | Specialist/Technologist, Other | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2016-08-31 |
| 1902271190 | Kerry Coenen | Specialist/Technologist, Other | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2015-12-14 |
| 1447593835 | Jeremiah Olson | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401 | 2013-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
| 1376161976 | Family Foot and Ankle Clinic LLC | Podiatrist | 1901 Westwood Boulevard, Wausau, WI 54401 | 2020-07-09 |
| 1336701895 | Amy Kluetz | Counselor | 3000 Westhill Drive, Suite 100, Wausau, WI 54401 | 2019-07-05 |
| 1437640877 | Joseph T Fitz | Student in an Organized Health Care Education/Training Program | Aspirus Wausau Family Medicine, 425 Wind Ridge Drive, Wausau, WI 54401 | 2018-05-22 |
| 1699293241 | Amanda Nedd | Dietitian, Registered | 425 Pine Ridge Boulevard Suite 220 C, Wausau, WI 54401 | 2017-09-05 |
| 1396287447 | Dee Cha | Nurse Anesthetist, Certified Registered | 4851 Rachel Ln Apt 5, Wausau, WI 54401 | 2016-11-07 |
| 1013389618 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 2727 Plaza Dr., Wausau, WI 54401 | 2015-10-22 |
| 1881091163 | Judy Lao | Dental Hygienist | 413 North 17th Avenue, Wausau, WI 54401 | 2014-12-02 |
| 1295012011 | Allison Waraksa | Pharmacist | 504 S. 17th Ave, Wausau, WI 54401 | 2011-11-08 |
| 1881974053 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 504 S 17th Ave, Wausau, WI 54401 | 2011-08-19 |
| Find all providers in zip 54401 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912952318 | Pamela G Galloway | Surgery | 1506 Pine View Ln, Wausau, WI 54403-2361 | 2006-05-23 |
| 1558363432 | James P. Binder | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2005-08-11 |
| 1548600190 | John J Petronovich | Surgery | 2727 Plaza Dr, Wausau, WI 54401-4129 | 2013-06-27 |
| 1447593835 | Jeremiah Olson | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401 | 2013-04-03 |
| 1548451230 | Breast Center of Central Wisconsin, S.c | Surgery | 1506 Pine View Ln, Wausau, WI 54403-2361 | 2007-08-07 |
| 1023229382 | Gary Theodore Sweet Jr. | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2007-05-25 |
| 1306993332 | Benjamin James Herdrich | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2007-01-04 |
| 1619997046 | William A Wilfley Jr. | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2006-07-20 |
| 1710910476 | Surgical Associates, S.c. | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401-7803 | 2006-07-08 |
| 1477599603 | Dennis J. Costa | Surgery | 2400 Pine Ridge Blvd, Wausau, WI 54401 | 2006-06-22 |
| Find all providers in WAUSAU | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.