Provider Demographics
NPI:1982404372
Name:CONNERY-LARSCHEID, MICHELLE LYNN (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:CONNERY-LARSCHEID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CONNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:20876 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5878
Mailing Address - Country:US
Mailing Address - Phone:651-491-8181
Mailing Address - Fax:
Practice Address - Street 1:20876 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5878
Practice Address - Country:US
Practice Address - Phone:651-491-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL574756164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse