Healthcare Provider Details

I. General information

NPI: 1467447896
Provider Name (Legal Business Name): DOUGLAS SCOTT LARNER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 SKYWAY DR
BOULDER CO
80303-5100
US

IV. Provider business mailing address

738 SKYWAY DR
BOULDER CO
80303-5100
US

V. Phone/Fax

Practice location:
  • Phone: 720-520-3122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0992720-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013876
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0000010682
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberAPN.0992720-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAPN.0992720-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: