Provider Demographics
NPI:1346972361
Name:LARSEN, ELIZABETH DANIELLE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANIELLE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E CENTRAL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4019
Mailing Address - Country:US
Mailing Address - Phone:701-838-1812
Mailing Address - Fax:
Practice Address - Street 1:400 E CENTRAL AVE STE 302
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4019
Practice Address - Country:US
Practice Address - Phone:701-838-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator