Provider Demographics
NPI:1376800136
Name:GURLEY-LARSON, DAYNA HARRIS (LAC)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:HARRIS
Last Name:GURLEY-LARSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2506
Mailing Address - Country:US
Mailing Address - Phone:970-416-0444
Mailing Address - Fax:970-416-0888
Practice Address - Street 1:700 W MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2506
Practice Address - Country:US
Practice Address - Phone:970-416-0444
Practice Address - Fax:970-416-0888
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist