Individual
MICHAELA R LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
PO BOX 337, VALLEY, NE 68064-0337
(402) 359-2277
(402) 359-5432
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1068
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026480100
—
NE
05
—
1477585081
—
IA
05
—
47068731734
—
NE
05
—
47068731741
—
NE
05
—
47068731749
—
NE
05
—
47068731761
—
NE
01
—
470834610
TAX IDENIFICATION NUMBER
—
Enumeration date
07/06/2006
Last updated
03/07/2023
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