Individual
CALLIE S LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1815 WELLS ST, LAS CRUCES, NM 88003-1304
(505) 440-6297
Mailing address
17 PONKA RD, ESTANCIA, NM 87016-6758
(505) 440-6297
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/11/2021
Last updated
11/08/2023
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