Basic Information
| Provider Information | |||||||||
| NPI: | 1851966675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LARUTHIEA | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34700 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | OCONOMOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530664500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626464411 | ||||||||
| FaxNumber: | 2626461049 | ||||||||
| Practice Location | |||||||||
| Address1: | 4555 W SCHROEDER DR | ||||||||
| Address2: | |||||||||
| City: | BROWN DEER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532231475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007674411 | ||||||||
| FaxNumber: | 4147970804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 154583 | WI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.