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General NPI Number Information
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NPI Number | 1659782746
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Entity Type | Individual
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Provider Name | KATRINA LARSEN MS, RD, CDCES
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 152 S KOYUKUK AVE
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City | STAR
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State | ID
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Zip | 83669-1081
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Country | US
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Telephone | 541-561-5452
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44
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City | STAR
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State | ID
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Zip | 83669-0044
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Country | US
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Telephone | 541-561-5452
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 10161831
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License Number State | OR
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