Individual
MR. PAUL DANIEL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1 WALLACE BASHAW WAY, SUITE 2001, NEWBURYPORT, MA 01950-3875
(802) 777-6639
Mailing address
319 RIVER RD, ESSEX JUNCTION, VT 05452-4000
(802) 777-6639
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
101-0030149
VT
363LF0000X
Family Nurse Practitioner
Primary
RN2299514
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010942
—
VT
Enumeration date
08/15/2006
Last updated
05/28/2015
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