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General NPI Number Information
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NPI Number | 1770373383
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Entity Type | Individual
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Provider Name | STEPHANIE SHEVANNE LARSEN
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 10323 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-6071
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Country | US
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Telephone | 310-730-9236
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Fax | 310-469-9073
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Provider Business Mailing Address
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Address Line | 8500 WILSHIRE BLVD STE 740
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3105
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95035782
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License Number State | CA
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