Provider Demographics
NPI:1235734625
Name:LARSEN, DAVID CHRISTIAN (NP-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTIAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 S CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4137
Mailing Address - Country:US
Mailing Address - Phone:801-566-5350
Mailing Address - Fax:
Practice Address - Street 1:10011 SO. CENTENNIAL PARKWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-8407
Practice Address - Country:US
Practice Address - Phone:801-566-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8188301-4409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily