Individual
LARA HOUSEHOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 E PARK DR STE 105C, ATHENS, OH 45701-5003
(740) 423-4015
Mailing address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 861-5101
(207) 872-4341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34.016620
OH
Other
Enumeration date
06/09/2019
Last updated
09/06/2023
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