Provider Demographics
NPI:1073953345
Name:LARSEN, LAUREN E (RN-PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RN-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14691
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97293-0691
Mailing Address - Country:US
Mailing Address - Phone:503-782-8907
Mailing Address - Fax:503-386-3310
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-782-8907
Practice Address - Fax:503-386-3310
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201340303RN163W00000X
OR201501816NP363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500683937Medicaid
OR500683936Medicaid