Individual
MARK LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2373 AUGUSTA HWY, LEXINGTON, SC 29072-2213
(803) 951-0786
Mailing address
2373 AUGUSTA HWY, LEXINGTON, SC 29072-2213
(803) 951-0786
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19410
SC
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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