Healthcare Provider Details

I. General information

NPI: 1932057973
Provider Name (Legal Business Name): MARILYN LARSEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N COTNER BLVD
LINCOLN NE
68505-2371
US

IV. Provider business mailing address

1020 NORWOOD DR APT 204
LINCOLN NE
68512-2113
US

V. Phone/Fax

Practice location:
  • Phone: 402-287-6171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: