Provider Demographics
NPI:1942457247
Name:LARRICK, JENNIFER ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LARRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 ROAD 301
Mailing Address - Street 2:
Mailing Address - City:DEWEESE
Mailing Address - State:NE
Mailing Address - Zip Code:68934-3409
Mailing Address - Country:US
Mailing Address - Phone:402-262-2412
Mailing Address - Fax:308-398-6420
Practice Address - Street 1:3610 RICHMOND CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3927
Practice Address - Country:US
Practice Address - Phone:308-382-7744
Practice Address - Fax:308-382-7744
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101046367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered