STEPHEN LARSON (NPI# 1568465201) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568465201 |
| Entity Type | Individual |
| Full Name | STEPHEN LARSON |
| Credential | CRNA |
| Practice Address |
112 E 5th Ave Antigo WI 54409-2710 |
| Mailing Address |
1752 Edgewood Rd Winona MN 55987-2149 |
| Practice Telephone | 7156232331 |
| Enumeration Date | 2005-05-26 |
| Last Update Date | 2014-04-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 202157-30 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | R-081276-4 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43293000 | 05 | |
| MN | 136542800 | 05 | |
| CLIA | 52D0662095 | 01 | |
| IBAX | 1882 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487759619 | Stephen Mark Larson | Optometrist | 314 Main St S, Sauk Centre, MN 56378-1349 | 2006-09-13 |
| 1699883876 | Stephen James Larson | Dentist | 777 Cuesta Dr Ste 100, Mountain View, CA 94040-3765 | 2006-08-28 |
| 1649230160 | Stephen Larson | Psychologist | 352 Hommelville Rd, Saugerties, NY 12477-4205 | 2006-03-27 |
| 1851802680 | Stephen Michael Larson | Specialist | 6333 Telegraph Ave, Oakland, CA 94609-1359 | 2017-10-19 |
| 1972980928 | Stephen Larson | Otolaryngology | 1120 15th St, Augusta, GA 30912-3403 | 2015-04-29 |
| 1700205382 | Stephen Nathaniel Larson | Veterinarian | 2845 Harlem Ave, Berwyn, IL 60402-2800 | 2014-04-10 |
| 1972733467 | Stephen A Larson | Social Worker | 1100 K Ave, La Grande, OR 97850-2131 | 2009-07-20 |
| 1033276357 | Stephen Joseph Larson | Dentist | 612 Rockdale Ave, Cincinnati, OH 45229-2919 | 2007-01-03 |
| 1386755775 | Stephen Larson | Emergency Medicine | 12303 De Paul Dr, Bridgeton, MO 63044-2512 | 2006-08-31 |
| 1003838459 | Stephen M Larson | Dentist | 6411 Fannin St, Houston, TX 77030-1501 | 2006-07-24 |
| Street Address |
112 E 5TH AVE |
| City | ANTIGO |
| State | WI |
| Zip Code | 54409-2710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295381481 | Melissa Flannery | Nurse Practitioner | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-08-13 |
| 1285295105 | Samantha Jean Stimac | Physical Therapist | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-06-21 |
| 1467016899 | Nikole Lynn Larkin | Nurse Practitioner | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-05-01 |
| 1487218400 | Rachael Elizabeth Miller | Physical Therapist | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-04-24 |
| 1366908790 | Hannah Elizabeth Wenzlick | Physician Assistant | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-02-11 |
| 1700359106 | Stephanie Krautkramer | Speech-Language Pathologist | 112 E 5th Ave, Antigo, WI 54409-2710 | 2019-01-08 |
| 1710467444 | Carolyn Kelk | Dietitian, Registered | 112 E 5th Ave, Antigo, WI 54409-2710 | 2018-08-21 |
| 1982181913 | Courtney Lynn Mattek | Nurse Practitioner | 112 E 5th Ave, Antigo, WI 54409-2710 | 2018-07-23 |
| 1922593805 | Dylan Michael Graff | Physician Assistant | 112 E 5th Ave, Antigo, WI 54409-2710 | 2018-06-25 |
| 1568911097 | Aaron Wright | Nurse Practitioner | 112 E 5th Ave, Antigo, WI 54409-2710 | 2016-09-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454036 | Jason Peter Cueny | Pharmacist | 200 E Highway 64, Antigo, WI 54409 | 2020-10-15 |
| 1770194524 | Christpher George Rowe | Technician | 825 Clermont S Apt 7, Antigo, WI 54409 | 2020-08-14 |
| 1033753512 | Joseph Gerger | Technician | 711 Badger Ave, Antigo, WI 54409 | 2019-10-29 |
| 1225368780 | Integrated Pain Solutions LLC | Clinic/Center | 2327 Neva Road, Antigo, WI 54409 | 2010-01-06 |
| 1558525212 | Jessica E Rosenberg | Social Worker | 310 South Superior Street, Antigo, WI 54409 | 2008-07-11 |
| 1053433292 | Raymond J Portman | Dentist | 705 Fifth Ave, Antigo, WI 54409 | 2007-04-06 |
| 1699801316 | Rick L Perkins | Obstetrics & Gynecology | Aspirus General Clinic, 110 East 5th Avenue, Antigo, WI 54409 | 2007-02-26 |
| 1205999646 | Earl J Roth | Chiropractor | 612 Century Ave, Antigo, WI 54409 | 2006-12-18 |
| 1811061187 | Rosanne Schermetzler | Occupational Therapist | 720 Ackley Street, Antigo, WI 54409 | 2006-11-20 |
| 1912084070 | Antigo Total Therapy & Sports Rehab Center Inc | Physical Therapist | 720 Askley Street, Antigo, WI 54409 | 2006-11-01 |
| Find all providers in zip 54409 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912978099 | Stephen M. Kordiyak | Nurse Anesthetist, Certified Registered | 115 E 5th Ave, Antigo, WI 54409-2711 | 2006-01-27 |
| 1750366480 | Todd E. Anderson | Nurse Anesthetist, Certified Registered | 112 E 5th Ave, Antigo, WI 54409-2710 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154943637 | Michael Poeschel | Nurse Anesthetist, Certified Registered | 2109 E Capitol Dr Ste B, Appleton, WI 54911-8726 | 2020-05-07 |
| 1285148643 | River Valley Anesthesia, Inc. | Nurse Anesthetist, Certified Registered | 130 S. Knowles Ave., New Richmond, WI 54017 | 2017-11-21 |
| 1295278356 | Braden Williams | Nurse Anesthetist, Certified Registered | 955 Pheasant Creek Dr, Oshkosh, WI 54904 | 2016-11-22 |
| 1396287447 | Dee Cha | Nurse Anesthetist, Certified Registered | 4851 Rachel Ln Apt 5, Wausau, WI 54401 | 2016-11-07 |
| 1053790972 | Rest Assured Anesthesia Services LLC | Nurse Anesthetist, Certified Registered | 1200 John Q Hammons Dr Ste 102, Madison, WI 53717-1967 | 2015-05-26 |
| 1205223898 | Petagaye Tm Johnson | Nurse Anesthetist, Certified Registered | 5150 E Cheryl Pkwy Unit 301, Fitchburg, WI 53711-7659 | 2015-04-21 |
| 1568851194 | Nicholas Joseph Nuccio | Nurse Anesthetist, Certified Registered | 720 S Marquette St, #302, Racine, WI 53403-1174 | 2015-01-20 |
| 1285030452 | Garner Anesthesia Services LLC | Nurse Anesthetist, Certified Registered | 254 E Marquette St, Berlin, WI 54923-1298 | 2014-11-14 |
| 1073934048 | Lynne M Krebs Crna Sc | Nurse Anesthetist, Certified Registered | W178n9912 Rivercrest Dr Ste 102, Germantown, WI 53022-4645 | 2013-12-18 |
| 1831537679 | Roxanne Brault | Nurse Anesthetist, Certified Registered | 7929 S 66th St, Franklin, WI 53132-9281 | 2013-06-13 |
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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.