Individual
MRS. GAYLE S LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200460012CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027893
—
OR
01
—
1407812365
NBMC NPI NUMBER-GROUP
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/26/2005
Last updated
04/22/2009
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