Provider Demographics
NPI:1902248875
Name:LARSON, JENNY (CPM, RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:CPM, RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, RN
Mailing Address - Street 1:13220 S 154TH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13220 S 154TH ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4400
Practice Address - Country:US
Practice Address - Phone:480-664-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253938163WM0102X
374J00000X
AZLM197176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No374J00000XNursing Service Related ProvidersDoula