Healthcare Provider Details

I. General information

NPI: 1710774419
Provider Name (Legal Business Name): AMY LARSEN RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY DUNNE

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # 210
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

19012 SCHUSTER AVE
CASTRO VALLEY CA
94546-3057
US

V. Phone/Fax

Practice location:
  • Phone: 415-205-1316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number4531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: