Provider Demographics
NPI:1073403960
Name:LIBBY, LARRY WILLIAM
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:WILLIAM
Last Name:LIBBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 STEVEN CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0226
Mailing Address - Country:US
Mailing Address - Phone:712-254-6550
Mailing Address - Fax:
Practice Address - Street 1:1942 S 42ND ST
Practice Address - Street 2:STE 122
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-346-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist