MEDICARE: BRITTANY NICOLE LARSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		NV

General Provider Information

NPI Number	:	1396260428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY NICOLE LARSEN

Provider Business Mailing Address
First Line	:	2416 PEBBLE SPRINGS CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6317
Country	:	US
Telephone Number	:	702-445-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 S WATER ST # 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7226
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/09/2017

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Directions to “ BRITTANY NICOLE LARSEN ” Practice Location

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