Provider Demographics
NPI:1811972516
Name:LARSEN MCKENNA, PATRICIA (CRNA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:LARSEN MCKENNA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 EVERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2637
Mailing Address - Country:US
Mailing Address - Phone:408-896-6000
Mailing Address - Fax:
Practice Address - Street 1:126 EVERSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2637
Practice Address - Country:US
Practice Address - Phone:408-896-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024083218367500000X
MDAC000279367500000X
DCRN59684367500000X
CA969367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered