Provider Demographics
NPI:1306274782
Name:LARSEN, EVE (MS)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E 4500 S STE N160
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3617
Mailing Address - Country:US
Mailing Address - Phone:801-281-1100
Mailing Address - Fax:801-281-1936
Practice Address - Street 1:716 E 4500 S STE N160
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-281-1100
Practice Address - Fax:801-281-1936
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$Medicaid