Provider Demographics
NPI:1629769799
Name:LARSEN, DANI (RN, FDN-P)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RN, FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-1251
Mailing Address - Country:US
Mailing Address - Phone:920-418-3628
Mailing Address - Fax:
Practice Address - Street 1:1003 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-1251
Practice Address - Country:US
Practice Address - Phone:920-418-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
WI171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach