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General NPI Number Information
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NPI Number | 1801245246
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Entity Type | Individual
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Provider Name | KELLY ANN LARSEN CRNA, DNAP, MSN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 9023 E DESERT COVE AVE STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6779
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Country | US
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Telephone | 480-407-6400
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Fax | 480-407-6520
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Provider Business Mailing Address
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Address Line | 4622 E LE MARCHE AVE
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City | PHOENIX
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State | AZ
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Zip | 85032-4218
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Country | US
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Telephone | 619-971-0312
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Fax | 480-407-6520
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA1231
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License Number State | AZ
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