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1497120349
CHARLES BLAISE LARSON
TWIN FALLS, ID
NPI
1497120349
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: ID NP-1716A)
Enumeration Date
2015-12-03
Last Update Date
2016-05-09
Business Address
-- CHARLES BLAISE LARSON FNP-BC
730 N COLLEGE RD STE B
TWIN FALLS, ID 83301-3382
Phone number: 208-814-7350
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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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