Individual
LARISSA MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
172 2ND ST S, NAMPA, ID 83651-3708
(208) 489-5950
Mailing address
172 2ND ST S, NAMPA, ID 83651-3708
(208) 489-5950
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD 2109
ID
Other
Enumeration date
08/03/2010
Last updated
11/10/2014
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