Individual
BLAIR ELIZABETH LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1907
(570) 326-8005
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061129
PA
363AM0700X
Medical Physician Assistant
MA061129
PA
Other
Enumeration date
09/26/2019
Last updated
08/03/2023
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