Provider Demographics
NPI:1659782746
Name:LARSEN, KATRINA (MS, RD, CDCES)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 FIR CT
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-2979
Mailing Address - Country:US
Mailing Address - Phone:541-561-5452
Mailing Address - Fax:
Practice Address - Street 1:2886 FIR CT
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-2979
Practice Address - Country:US
Practice Address - Phone:541-561-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10161831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered