Healthcare Provider Details

I. General information

NPI: 1467372151
Provider Name (Legal Business Name): REBECCA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 3RD AVE SE PO BOX 735
CROSBY ND
58730-0735
US

IV. Provider business mailing address

301 3RD AVE SE PO BOX 735
CROSBY ND
58730-0735
US

V. Phone/Fax

Practice location:
  • Phone: 701-339-7580
  • Fax:
Mailing address:
  • Phone: 701-339-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number30244
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30244
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number30244
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: