Organization
VITALIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAUN LARSEN OD (OWNER)
(801) 910-4746
Entity
Organization
Contact information
Practice address
13553 S REDWOOD RD, RIVERTON, UT 84065-5734
(801) 910-4746
Mailing address
13553 S REDWOOD RD, RIVERTON, UT 84065-5734
(801) 910-4746
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/11/2024
Last updated
08/16/2024
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