Provider Information for 1821435702
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Mrs. SARAH HILLARY LARSEN M.A.C.
Other Names:Former Name:Miss SARAH LARSEN ASTRONESSex: Female
NPI: 1821435702
Last Updated: 2024-11-25
Certification Date: 2024-11-25
Certification Date: 2024-11-25
Details
Name | Value | ||||||||
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NPI | 1821435702 | ||||||||
Enumeration Date | 2013-05-31 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 1811 W 2ND ST STE 475 GRAND ISLAND, NE 68803-5413 United States Phone: 308-850-3509 | Fax:308-381-5698 | ||||||||
Primary Practice Address | 428 MONTEMAR AVE APT D CATONSVILLE, MD 21228-5297 United States Phone: 308-850-3509 | Fax:308-381-5698 | ||||||||
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