Provider Demographics
NPI:1659462000
Name:WHITING, LARRY MARVIN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MARVIN
Last Name:WHITING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 EAST 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-1622
Mailing Address - Country:US
Mailing Address - Phone:308-784-4261
Mailing Address - Fax:308-784-5016
Practice Address - Street 1:300 EAST 12TH STREET
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130
Practice Address - Country:US
Practice Address - Phone:308-784-2261
Practice Address - Fax:308-784-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100118367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered