Individual
PETER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
3525 E LOUISE DR STE 400, MERIDIAN, ID 83642-6303
(208) 322-1680
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
55261
ID
Other
Enumeration date
03/02/2017
Last updated
12/06/2021
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