Provider Demographics
NPI:1467869008
Name:LARSON, HILLARY LAUREN (SURGICAL TECH)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:LAUREN
Last Name:LARSON
Suffix:
Gender:F
Credentials:SURGICAL TECH
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:LAUREN
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SURGICAL TECH
Mailing Address - Street 1:2509 W 134TH CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5116
Mailing Address - Country:US
Mailing Address - Phone:510-938-8809
Mailing Address - Fax:
Practice Address - Street 1:2509 W 134TH CIR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5116
Practice Address - Country:US
Practice Address - Phone:510-938-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COST0002730246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist