Individual provider Active NPI

Nicole Elizabeth Larva

  • Adult Health Nurse Practitioner
  • Dayton, OH
National Provider Identifier
1598233157
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN.CNP.024609 Issued in OH
Practice address
1 Wyoming St
Dayton, OH 45409-2711
Phone
(937) 208-8000
NPI assigned
Nov 12, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X APRN.CNP.024609 OH Primary
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X APRN.CNP.024609 OH
Registered Nurse 163W00000X RN288497 OH

Addresses

Primary practice location

1 Wyoming St
Dayton, OH 45409-2711

Mailing address

3170 Kettering Blvd
Building B 3Rd Floor
Moraine, OH 45439-1924
Phone (937) 991-3188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20190523002865 OH Practitioner - Nurse Practitioner 2860735313 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN288497OHMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc Multi-Specialty CurrentSince May 13, 2019 Accepting new patients
Premier Health Specialists Inc Multi-Specialty CurrentSince May 13, 2019 Accepting new patients

Locations

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

2300 Miami Valley Dr
Ste 350
Dayton, OH 45459
Phone (937) 424-2469

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

3170 Kettering Blvd
Bldg B
Moraine, OH 45439
Phone (937) 991-3187

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Interoperability endpoints

  • Direct secure messaging: nlarva341201@direct.trihealth.com

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1598233157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 KETTERING BLVD",
            "address_2": "BUILDING B 3RD FLOOR",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391924",
            "telephone_number": "937-991-3188",
            "fax_number": "937-223-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092711",
            "telephone_number": "937-208-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARVA",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-12",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.024609",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.024609",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN288497",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.