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Individual

CHARLES BLAISE LARSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
FNP-BC

Contact information

Practice address
730 N COLLEGE RD STE B, TWIN FALLS, ID 83301-3382
(208) 814-7350
Mailing address
730 NTH COLLEGE RD # B, TWIN FALLS, ID 83301-3382
(208) 732-3066

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1716A
ID

Other

Enumeration date
12/03/2015
Last updated
05/09/2016
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