Provider Demographics
NPI:1861142549
Name:LARSEN, DONNA (MS NUTRITION)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1317
Mailing Address - Country:US
Mailing Address - Phone:347-426-6514
Mailing Address - Fax:
Practice Address - Street 1:42 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1317
Practice Address - Country:US
Practice Address - Phone:347-426-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist