| Stephen Larson, CRNA | |
|
112 E 5th Ave, Antigo, WI 54409-2710 | |
| (715) 623-2331 | |
| Not Available |
| Full Name | Stephen Larson |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 112 E 5th Ave, Antigo, Wisconsin |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568465201 | NPI | - | NPPES |
| 1882 | Other | IBAX | |
| 136542800 | Medicaid | MN | |
| 52D0662095 | Other | CLIA | |
| 43293000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | R-081276-4 (Minnesota) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 202157-30 (Wisconsin) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen Larson, CRNA 1752 Edgewood Rd, Winona, MN 55987-2149 Ph: () - | Stephen Larson, CRNA 112 E 5th Ave, Antigo, WI 54409-2710 Ph: (715) 623-2331 |
Todd E. Anderson, C.R.N.A. Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 112 E 5th Ave, Antigo, WI 54409 Phone: 715-623-2331 | |
Stephen M. Kordiyak, C.R.N.A. Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 115 E 5th Ave, Antigo, WI 54409 Phone: 715-623-2331 |