Provider Demographics
NPI:1144026360
Name:LARSON, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LARSON
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 1:502 E WALNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:NE
Mailing Address - Zip Code:68944-3004
Mailing Address - Country:US
Mailing Address - Phone:402-604-1354
Mailing Address - Fax:
Practice Address - Street 1:502 E WALNUT ST APT 2
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:NE
Practice Address - Zip Code:68944-3004
Practice Address - Country:US
Practice Address - Phone:402-604-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant