Individual
DANIELLE JEAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
255 CEDAR PARK CIR, TWIN FALLS, ID 83301-8911
(208) 308-0914
Mailing address
255 CEDAR PARK CIR, TWIN FALLS, ID 83301-8911
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
57249
ID
363LG0600X
Gerontology Nurse Practitioner
57249
ID
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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