Individual
HEIDI C LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2 W 42ND ST, SUITE 1200, SCOTTSBLUFF, NE 69361-0617
(308) 630-1811
Mailing address
2 W 42ND ST, SUITE 1200, SCOTTSBLUFF, NE 69361-0617
(308) 630-1811
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
782
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098637077
MEDICARE
NE
05
—
36331415914
—
NE
Enumeration date
11/08/2005
Last updated
11/09/2011
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