Individual
MR. MARK WAYNE LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN-E, FNP-C, CEN
Contact information
Practice address
901 ADAMS ST, AFTON, WY 83110-9621
(885) 885-5800
Mailing address
585 W 7615 S, WILLARD, UT 84340-9525
(435) 979-7546
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1758.1758
WY
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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