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NPI Code Detail

MEDICARE: WESLEY REED LARSEN APRN

MEDICARE: WESLEY REED LARSEN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5121976-4405UT

General Provider Information

NPI Number : 1174770440
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY REED LARSEN APRN
Provider Business Mailing Address
First Line : 1055 N 300 W STE 400
Second Line :
City : PROVO
State : UT
Zip : 84604-3359
Country : US
Telephone Number : 801-357-7404
Fax Number : 801-357-7587
Provider Business Practice Location Address
First Line : 3550 N UNIVERSITY AVE STE 250
Second Line :
City : PROVO
State : UT
Zip : 84604-6695
Country : US
Telephone Number : 801-374-9625
Fax Number : 801-374-9690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 05/26/2021

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Directions to “ WESLEY REED LARSEN APRN” Practice Location

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