Individual
DR. MARY KATHRYN ANN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
976 S 1925 W, OREM, UT 84059-2306
(760) 420-9859
Mailing address
976 S 1925 W, OREM, UT 84059-2306
(760) 420-9859
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11831283-4405
UT
363LA2100X
Acute Care Nurse Practitioner
Primary
11831283-4405
UT
363LA2200X
Adult Health Nurse Practitioner
11831283-4405
UT
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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