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Individual

BRANDY LEE LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
808 PANCHERI DR, IDAHO FALLS, ID 83402-3344
(208) 557-2900
(208) 557-2910
Mailing address
3450 POTOMAC WAY, IDAHO FALLS, ID 83404-4970
(208) 557-2900
(208) 557-2910

Taxonomy

Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
CNP60357
ID
363L00000X
Nurse Practitioner
60357
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1730652280
ID
Enumeration date
01/08/2019
Last updated
10/31/2022
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