Individual
MRS. RONDA L LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
807 N ASH ST, GORDON, NE 69343-1132
(308) 282-1442
(308) 282-1428
Mailing address
807 N ASH ST, GORDON, NE 69343-1132
(308) 282-1442
(308) 282-1428
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
590
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37347
BCBS
NE
01
—
6280
MIDLANDS CHOICE
NE
05
—
NE590
—
NE
Enumeration date
09/29/2006
Last updated
07/08/2007
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