JEANNIE THERESE LARSON (NPI# 1164406369) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164406369 |
| Entity Type | Individual |
| Full Name | JEANNIE THERESE LARSON |
| Credential | MD |
| Practice Address |
9555 Upland Lane N Maple Grove MN 55369 |
| Mailing Address |
8170 33rd Ave S P.o. Box 1309 Mail Stop 21110q Minneapolis MN 55425-4516 |
| Practice Telephone | 9529933260 |
| Mailing Telephone | 9529933260 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-08-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 33568 | MN | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
33568 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
9555 UPLAND LANE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184980518 | Kimberly Ann Ollinger | Internal Medicine | 9555 Upland Lane N, Maple Grove, MN 55369 | 2012-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770115610 | Dermatology Partners Pllc | Dermatology | 4041 28th St Nw Ste 200, Rochester, MN 55901-7943 | 2020-02-09 |
| 1023460243 | Ji Won Ahn | Dermatology | 200 1st St Sw, Rochester, MN 55905-5902 | 2016-07-12 |
| 1487018263 | Sama Kassira Carley | Dermatology | 200 1st St Sw, Rochester, MN 55905-0001 | 2016-04-07 |
| 1740532340 | Clarus Dermatology Pa | Dermatology | 2603 39th Ave Ne, Suite D-202, Minneapolis, MN 55421-4372 | 2012-10-05 |
| 1598925513 | Ian A Maher | Dermatology | 909 Fulton St Se, Minneapolis, MN 55455 | 2008-06-12 |
| 1235323585 | Bart Theodore Endrizzi | Dermatology | 420 Delaware St Se, Minneapolis, MN 55455-0341 | 2007-08-29 |
| 1730206541 | Michael Robert Campoli | Dermatology | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2007-03-25 |
| City | MAPLE GROVE |
| Zip Code | 55369 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.