Provider Demographics
NPI:1922983840
Name:JASA, LARRY JAMES JR
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:JASA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 6TH CORSO
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-2749
Mailing Address - Country:US
Mailing Address - Phone:402-209-3249
Mailing Address - Fax:
Practice Address - Street 1:1212 6TH CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2749
Practice Address - Country:US
Practice Address - Phone:402-209-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion