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Individual

MARLA JEAN VAN TASSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
414 SHOUP AVE W STE B, TWIN FALLS, ID 83301-5042
(208) 814-9100
Mailing address
414 SHOUP AVE W STE B, TWIN FALLS, ID 83301-5042
(208) 814-9100

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP-1662A
ID

Other

Enumeration date
10/06/2015
Last updated
02/23/2021
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