Healthcare Provider Details

I. General information

NPI: 1144988544
Provider Name (Legal Business Name): SLOAN PEARCE LARSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-2325
  • Fax: 831-477-2330
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: