Provider Demographics
NPI:1194491852
Name:LARSON, VICTORIA N (ISP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:LARSON
Suffix:
Gender:F
Credentials:ISP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 BARTON RD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3839
Mailing Address - Country:US
Mailing Address - Phone:440-463-6485
Mailing Address - Fax:
Practice Address - Street 1:5580 BARTON RD UNIT 302
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3839
Practice Address - Country:US
Practice Address - Phone:440-463-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health