Individual
MEGAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
287 W JEFFERSON ST, BOISE, ID 83702-6045
(208) 322-1680
Mailing address
287 W JEFFERSON ST, BOISE, ID 83702-6045
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
55148
ID
Other
Enumeration date
11/28/2016
Last updated
05/03/2017
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