Provider Demographics
NPI:1982799250
Name:LARSEN, JANELLE A (APRN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:A
Last Name:LARSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE47070592305Medicaid
NE47070592306Medicaid
NE10026072600Medicaid
NE47070592301Medicaid
NE47070592302Medicaid
NE4707592313Medicaid
NE47070592300Medicaid
NENA1080027Medicare PIN
NE271059Medicare PIN
NE10026072500Medicaid
NE500021818Medicare PIN
NENA1079037Medicare PIN
NE47070592301Medicaid