Healthcare Provider Details

I. General information

NPI: 1821877150
Provider Name (Legal Business Name): NATHAN STEPHEN LARSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-7848
US

IV. Provider business mailing address

570 MAIN ST
BENTON PA
17814-7848
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6763
  • Fax:
Mailing address:
  • Phone: 570-316-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number985480
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN728840
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: