Provider Demographics
NPI:1629612254
Name:LARSEN, SAPHIRE DAWN CHRISTINE (PDHA1)
Entity Type:Individual
Prefix:MS
First Name:SAPHIRE
Middle Name:DAWN CHRISTINE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PDHA1
Other - Prefix:MS
Other - First Name:SAPHIRE
Other - Middle Name:DAWN CHRISTINE
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PDHA1
Mailing Address - Street 1:222 TONGASS DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9416
Mailing Address - Country:US
Mailing Address - Phone:907-966-8343
Mailing Address - Fax:907-966-8663
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-8343
Practice Address - Fax:907-966-8663
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19-155-PDHAI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK19-155OtherPDHA 1