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Individual

JILL J LARSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
151 S UNIVERSITY AVE # 1900, PROVO, UT 84601-4427
(801) 851-7047
(801) 851-7055
Mailing address
151 S UNIVERSITY AVE # 1900, PROVO, UT 84601-4427
(801) 851-7047
(801) 851-7055

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
60862043102
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1225109036
UT
05
1891865010
UT
Enumeration date
04/11/2008
Last updated
04/11/2008
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