Healthcare Provider Details

I. General information

NPI: 1659782746
Provider Name (Legal Business Name): KATRINA LARSEN MS, RD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S KOYUKUK AVE
STAR ID
83669-1081
US

IV. Provider business mailing address

PO BOX 44
STAR ID
83669-0044
US

V. Phone/Fax

Practice location:
  • Phone: 541-561-5452
  • Fax:
Mailing address:
  • Phone: 541-561-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10161831
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: