Healthcare Provider Details

I. General information

NPI: 1518050897
Provider Name (Legal Business Name): QUENLYN J. LARSON C.N.P. DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E ROMIE LANE SUITE K
SALINAS CA
93901-4072
US

IV. Provider business mailing address

10460 FAIRWAY LANE
CARMEL CA
93923
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-9066
  • Fax: 831-422-4312
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN-187859
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP 19804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: