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General NPI Number Information
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NPI Number | 1932056140
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Entity Type | Individual
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Provider Name | CAMRON LARSEN
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Gender | Male
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 1909 FRONT ST
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City | BLAIR
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State | NE
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Zip | 68008-1524
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Country | US
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Telephone | 402-720-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 COLFAX ST
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City | BLAIR
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State | NE
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Zip | 68008-1911
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Country | US
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Telephone |
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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