Provider Demographics
NPI:1356489041
Name:LARSEN, DORIAN LAMONT (FNP)
Entity Type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:LAMONT
Last Name:LARSEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9034
Mailing Address - Country:US
Mailing Address - Phone:208-476-4511
Mailing Address - Fax:208-476-7898
Practice Address - Street 1:1443 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2558
Practice Address - Country:US
Practice Address - Phone:509-222-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-508A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily