Provider Demographics
NPI:1689475444
Name:LARSON, ELICIA
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:
Last Name:LARSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-4034
Mailing Address - Country:US
Mailing Address - Phone:605-660-6787
Mailing Address - Fax:
Practice Address - Street 1:1512 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:NE
Practice Address - Zip Code:68730-4034
Practice Address - Country:US
Practice Address - Phone:605-660-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant