Provider Demographics
NPI:1033567912
Name:HUNSBERGER, LARISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:HUNSBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3253
Mailing Address - Country:US
Mailing Address - Phone:402-326-4362
Mailing Address - Fax:
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-483-8600
Practice Address - Fax:402-483-8693
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant