Healthcare Provider Details

I. General information

NPI: 1659093581
Provider Name (Legal Business Name): SHALYN CHRISTINE LARSEN MSN, APRN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

345 W 1800 S
OREM UT
84058-7564
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3400
  • Fax:
Mailing address:
  • Phone: 402-200-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10000469
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number12013616-3102
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10000469
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: