Amanda Larson, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

C107295 Issued in IA

Practice address

420 12TH St SE
Apt 16
Le Mars, IA 51031-2800

Phone

(712) 541-1401

NPI assigned

Mar 23, 2015

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Omaha Tribe of Nebraska

  • Dental Clinic/Center
  • Macy, NE
  • NPI 1871977918

  TX

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 25, 2015.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1457745986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 12TH ST SE",
            "address_2": "APT 16",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312800",
            "telephone_number": "712-541-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 12TH ST SE",
            "address_2": "APT 16",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312800",
            "telephone_number": "712-541-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "AMANDA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-23",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C107295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA BOARD OF NURSING",
            "identifier": "107295",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Michael Langel, DC
• Jordan Langel, OD
• Kaylee Rae Langel, DC
• Rachel Langel, AGPCNP
• Jennifer Alma Larsen
• Anthony T Larson, PSY.D.
• Le Mars Area Dialysis Services
• Le Mars Dental Center
• Le Mars Eye Care , PC
• Le Mars Physical Therapy

• All providers in Le Mars, IA
• Pediatric Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.