Individual
MS. VICKI J LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2914 E POWERLINE RD, NAMPA, ID 83687-4920
(208) 353-0329
Mailing address
2914 E POWERLINE RD, NAMPA, ID 83687-4920
(208) 353-0329
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806519600
—
ID
Enumeration date
05/28/2008
Last updated
05/28/2008
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