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General NPI Number Information
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NPI Number | 1285110189
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Entity Type | Individual
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Provider Name | NESERIANI LARSEN LISW
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 601 GRAND AVE
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City | DES MOINES
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State | IA
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Zip | 50309-2501
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Country | US
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Telephone | 515-237-5045
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Fax |
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Provider Business Mailing Address
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Address Line | 3912 80TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-2416
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Country | US
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Telephone | 815-383-0307
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082662
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License Number State | IA
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