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General NPI Number Information
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NPI Number | 1477585081
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Entity Type | Individual
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Provider Name | MICHAELA R LARSEN P.A.C.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | PO BOX 337
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City | VALLEY
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State | NE
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Zip | 68064-0337
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Country | US
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Telephone | 402-359-2277
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Fax | 402-359-5432
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Provider Business Mailing Address
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Address Line | PO BOX 3755
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City | OMAHA
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State | NE
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Zip | 68103-0755
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Country | US
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Telephone | 402-354-2100
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Fax | 402-354-2155
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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 | 1068
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License Number State | NE
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