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General NPI Number Information
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NPI Number | 1093564932
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Entity Type | Individual
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Provider Name | LARISSA UMBERGER PA-S3
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Gender | Female
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Dates
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Enumeration Date | 05/14/2024
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 1250 VALLEY VIEW DR
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City | DELTA
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State | CO
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Zip | 81416-3138
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Country | US
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Telephone | 970-874-8981
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | OLATHE
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State | CO
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Zip | 81425-0529
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Country | US
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Telephone | 703-236-1419
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009312
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License Number State | CO
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