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General NPI Number Information
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NPI Number | 1578879441
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Entity Type | Individual
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Provider Name | GREG ERIC LARSEN APRN
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Gender | Male
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Dates
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Enumeration Date | 08/29/2010
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 624 S 1000 E STE 103
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City | ST GEORGE
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State | UT
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Zip | 84790-5902
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Country | US
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Telephone | 435-652-1135
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Fax | 435-652-1190
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Provider Business Mailing Address
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Address Line | 624 S 1000 E STE 103
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City | ST GEORGE
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State | UT
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Zip | 84790-5902
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Country | US
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Telephone | 435-652-1135
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Fax | 435-652-1190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 354177-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 354177-4405
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License Number State | UT
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