Provider Demographics
NPI:1073082269
Name:LARSON, CHRISTINE E (CPM, LDEM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:LARSON
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 M ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3850
Mailing Address - Country:US
Mailing Address - Phone:801-867-5943
Mailing Address - Fax:801-210-7954
Practice Address - Street 1:85 M ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3850
Practice Address - Country:US
Practice Address - Phone:801-867-5943
Practice Address - Fax:801-210-7954
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11049874-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife