Healthcare Provider Details

I. General information

NPI: 1316585755
Provider Name (Legal Business Name): VICTORIA MARIE LARWIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 300 S
SPANISH FORK UT
84660-2014
US

IV. Provider business mailing address

11187 S 2865 W
SOUTH JORDAN UT
84095-8438
US

V. Phone/Fax

Practice location:
  • Phone: 801-518-6072
  • Fax:
Mailing address:
  • Phone: 801-618-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95032647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8170254-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: