Susan Larson, | |
1020 35th Street, Kenosha, WI 53140 | |
(262) 767-6487 | |
Not Available |
Full Name | Susan Larson |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 1020 35th Street, Kenosha, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1588370902 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | 3633-29 (Wisconsin) | Secondary |
133V00000X | Dietitian, Registered | 812643 (Illinois) | Primary |
Provider Name | Aurora Medical Group, Inc. |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1427271378 PECOS PAC ID: 6709794258 Enrollment ID: O20031105000725 |
Mailing Address | Practice Location Address |
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Susan Larson, 1020 35th Street, Kenosha, WI 53140-1902 Ph: (262) 767-6487 | Susan Larson, 1020 35th Street, Kenosha, WI 53140 Ph: (262) 767-6487 |
Mr. Dean Spangle, MS, RD, CD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1617 73rd St, Kenosha, WI 53143 Phone: 262-653-1771 | |
Abigail Jean Olcott, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 13032 71st St Apt 7118, Kenosha, WI 53142 Phone: 309-397-6406 | |
Kara Winslow, M.S., R.D., C.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-7083 Fax: 262-948-7086 | |
Emily Jane Collins, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 4536 22nd Ave, Kenosha, WI 53140 Phone: 262-646-0044 | |
Lindsay Swartz, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 10400 75th St Ste 316, Kenosha, WI 53142 Phone: 262-948-6692 | |
Jaclyn Jozefiak, RDN, MS Dietitian Medicare: Medicare Enrolled Practice Location: 6838 93rd Ct, Kenosha, WI 53142 Phone: 262-909-9282 | |
Megan Labine, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-7084 |