Provider Demographics
NPI:1831940485
Name:LARKIN, ALISSE V (RDN)
Entity type:Individual
Prefix:
First Name:ALISSE
Middle Name:V
Last Name:LARKIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AGGIE VLG APT L
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2633
Mailing Address - Country:US
Mailing Address - Phone:435-255-7484
Mailing Address - Fax:
Practice Address - Street 1:15 AGGIE VLG APT L
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2633
Practice Address - Country:US
Practice Address - Phone:435-255-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86326128133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics