Provider Demographics
NPI:1578360699
Name:LARSEN, JOHN MURRAY (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MURRAY
Last Name:LARSEN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 CHAMBERS ST STE 5
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5082
Mailing Address - Country:US
Mailing Address - Phone:801-605-3801
Mailing Address - Fax:
Practice Address - Street 1:6936 S PROMENADE DR STE 202
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3387
Practice Address - Country:US
Practice Address - Phone:801-605-3801
Practice Address - Fax:801-752-3068
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7947701-3102163WC0200X
UT7947701-8900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine