Provider Demographics
NPI:1205419884
Name:LARSEN, SHEILA ADEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ADEL
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1320 N MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-1230
Mailing Address - Country:US
Mailing Address - Phone:435-586-1276
Mailing Address - Fax:435-586-1327
Practice Address - Street 1:1320 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-1230
Practice Address - Country:US
Practice Address - Phone:435-586-1276
Practice Address - Fax:435-586-1327
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13287153-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant