Jeannie Therese Larson
Dermatologist MOHS-Micrographic Surgeon
9555 Upland Lane N
Maple Grove
, Minnesota 55369
Jeannie Therese Larson
Dermatologist MOHS-Micrographic Surgeon
9555 Upland Lane N
Maple Grove
, Minnesota 55369
(952) 993-3260
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Jeannie Therese Larson
- 8170 33rd Ave S P.o. Box 1309 Mail Stop 21110q
- Minneapolis, MN
- Zip : 55425-4516
- Phone : (952) 993-3260
Second Address
- Jeannie Therese Larson
- 9555 Upland Lane N
- Maple Grove, MN
- Zip : 55369
- Phone : (952) 993-3260
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Is Jeannie Therese Larson a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207N00000X | Dermatologist | 33568 | MN |
| Y | 207ND0101X | MOHS-Micrographic Surgeon | 33568 | MN |
National Provider Identifier
| NPI | 1164406369 |
|---|---|
| Provider Name | Jeannie Therese Larson |
| First Address | Minneapolis, MN 55425-4516 |
| Second Address | Maple Grove, MN 55369 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/12/2005 |
| Last Update Date | 14/08/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.