Provider Demographics
NPI:1013358092
Name:LARSEN, WHITNEY KAY (CNP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:KAY
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:KAY
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:196 E 6TH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5939
Mailing Address - Country:US
Mailing Address - Phone:605-480-1975
Mailing Address - Fax:
Practice Address - Street 1:521 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104
Practice Address - Country:US
Practice Address - Phone:605-367-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000797363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily