MEDICARE: QUENLYN J. LARSON C.N.P. DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	RN-187859	OH
2	363LP0200X	Pediatric Nurse Practitioner	NP 19804	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518050897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENLYN J. LARSON C.N.P. DNP

Provider Business Mailing Address
First Line	:	5841 JAMESON CT
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0895
Country	:	US
Telephone Number	:	916-485-9800
Fax Number	:	916-485-9810

Provider Business Practice Location Address
First Line	:	1580 CREEKSIDE DR STE 200
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3888
Country	:	US
Telephone Number	:	916-924-9337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	02/18/2026

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