Provider Demographics
NPI:1518050897
Name:LARSON, QUENLYN J (CNP DNP)
Entity Type:Individual
Prefix:
First Name:QUENLYN
Middle Name:J
Last Name:LARSON
Suffix:
Gender:F
Credentials:CNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 FAIRWAY LANE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:550 E ROMIE LANE
Practice Address - Street 2:SUITE K
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4072
Practice Address - Country:US
Practice Address - Phone:831-422-9066
Practice Address - Fax:831-422-4312
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-187859363LP0200X
CANP 19804363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2350254Medicaid