Individual
MRS. RENEE L. LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1962 CHARLIE HALL BLVD., CHARLESTON, SC 29414
(843) 722-8000
(843) 723-7850
Mailing address
1962 CHARLIE HALL BLVD., CHARLESTON, SC 29414
(843) 722-8000
(843) 723-7850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A817
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0092PA
—
SC
Enumeration date
07/14/2005
Last updated
08/05/2011
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