Provider Demographics
NPI:1871950857
Name:LARSEN, MEGAN (CRNA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 E SHEA BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6662
Mailing Address - Country:US
Mailing Address - Phone:480-256-1520
Mailing Address - Fax:480-478-6628
Practice Address - Street 1:8424 E SHEA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6662
Practice Address - Country:US
Practice Address - Phone:480-256-1520
Practice Address - Fax:480-478-6628
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN195925163W00000X
AZCRNA1199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse