Provider Demographics
NPI:1366045577
Name:GREENFIELD, LARSON (RN)
Entity Type:Individual
Prefix:
First Name:LARSON
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 AUTOMATION WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5738
Mailing Address - Country:US
Mailing Address - Phone:719-688-8732
Mailing Address - Fax:
Practice Address - Street 1:3702 AUTOMATION WAY STE 103
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5738
Practice Address - Country:US
Practice Address - Phone:970-224-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996947-CRNA367500000X
TN210609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse