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General NPI Number Information
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NPI Number | 1578781480
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Entity Type | Organization
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Legal Business Name | BARBARA S. LARSON
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 35555 KENAI SPUR HWY
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City | SOLDOTNA
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State | AK
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Zip | 99669-7625
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Country | US
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Telephone | 907-260-3975
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Fax | 907-262-3883
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Provider Business Mailing Address
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Address Line | 35555 KENAI SPUR HWY PMB 406
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City | SOLDOTNA
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State | AK
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Zip | 99669-7625
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Country | US
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Telephone | 907-260-3975
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Fax | 907-262-3883
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Authorized Official
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Title or Position | OWNER, CARE COORDINATOR
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Name | VARVARA (BARBARA) SEDIAKINA-LARSON
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Credential | BA MDIV, CHAPLAIN
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Telephone | 907-260-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | AK
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