Larry Earl Underdue

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

License

1478491 Issued in ND

Practice address

420 E Main Ave Apt 1011
Bismarck, ND 58501-4069

Phone

(701) 204-1642

NPI assigned

Nov 20, 2020

Last updated

Nov 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1790388718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E MAIN AVE APT 1011",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014069",
            "telephone_number": "701-204-1642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E MAIN AVE APT 1011",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014069",
            "telephone_number": "701-204-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERDUE",
        "first_name": "LARRY",
        "middle_name": "EARL",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "ND",
            "license": "1478491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Personal Care Attendant in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Personal Care Attendant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.