Individual
MR. LARRY LEE BOUSQUET II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1611 E JOY LN # 1, FORT MOHAVE, AZ 86426-8807
(928) 768-9496
(928) 768-1943
Mailing address
1611 E JOY LN, FORT MOHAVE, AZ 86426-8807
(928) 768-9496
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
283825
AZ
Other
Enumeration date
11/11/2022
Last updated
11/11/2022
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