Individual
LARRY CHANDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8512 WASHOE RD, PAYETTE, ID 83661-5424
(208) 405-5297
Mailing address
8512 WASHOE RD, PAYETTE, ID 83661-5424
(208) 405-5297
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
089003141RN
OR
Other
Enumeration date
07/12/2018
Last updated
07/12/2018
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