MEDICARE: DIANA LORRAINE LARSEN NP

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	163W00000X	Registered Nurse	NP545628	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	:	1619964244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LORRAINE LARSEN NP

Provider Business Mailing Address
First Line	:	PO BOX 1285
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-1285
Country	:	US
Telephone Number	:	530-458-5565
Fax Number	:	530-458-2838

Provider Business Practice Location Address
First Line	:	348 MARKET ST
Second Line	:	SUITE A
City	:	COLUSA
State	:	CA
Zip	:	95932-2422
Country	:	US
Telephone Number	:	530-458-5565
Fax Number	:	530-458-2838

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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