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General NPI Number Information
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NPI Number | 1003178724
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Entity Type | Individual
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Provider Name | ASHLEY MARIE LARSON MS, RD, LMNT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 7501 S 27TH ST
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City | LINCOLN
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State | NE
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Zip | 68512
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Country | US
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Telephone | 402-481-6316
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 W IRVING CIR
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City | LINCOLN
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State | NE
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Zip | 68521-3007
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Country | US
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Telephone | 402-469-4323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 868
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License Number State | NE
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