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Individual

DARREL PAULUS LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
10118 W OVERLAND RD, BOISE, ID 83709-1428
(208) 450-3856
Mailing address
10118 W OVERLAND RD, BOISE, ID 83709-1428

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
118966
OK
163W00000X
Registered Nurse
53419
ID
367500000X
Certified Registered Nurse Anesthetist
118966
OK
367500000X
Certified Registered Nurse Anesthetist
Primary
53419
ID

Other

Enumeration date
10/23/2015
Last updated
07/20/2016
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