Individual
MARIELLE CHLOE ALINE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
605 S COOLIDGE ST, MOSES LAKE, WA 98837-1873
(435) 557-6842
Mailing address
650 N 600 E, PROVO, UT 84606-1912
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.PA.61631353
WA
Other
Enumeration date
05/08/2023
Last updated
02/12/2025
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