CHARLES BLAISE LARSON

TWIN FALLS, ID
NPI1497120349
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: ID  NP-1716A)
Enumeration Date2015-12-03
Last Update Date2016-05-09
Business Address
-- CHARLES BLAISE LARSON FNP-BC
730 N COLLEGE RD STE B
TWIN FALLS, ID 83301-3382
Phone number: 208-814-7350
Mailing Address
-- CHARLES BLAISE LARSON FNP-BC
730 NTH COLLEGE RD # B
TWIN FALLS, ID 83301-3382
Phone number: 208-732-3066
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