Larson, Brandy Lee

Larson, Brandy Lee is an individual health care provider with primary practice located at 808 Pancheri Dr , Idaho Falls ID 83402-3344. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Allopathic & Osteopathic Physicians / Gynecologic Oncology. Allopathic & Osteopathic Physicians / Gynecologic Oncology is her primary health care specialty. Larson, Brandy Lee can be contacted via phone (208) 557-2900.

Contact Information

Primary practice address
808 Pancheri Dr Idaho Falls ID 83402-3344
Phone: (208) 557-2900
Fax: (208) 557-2910
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 60357 Idaho
Allopathic & Osteopathic Physicians / Gynecologic Oncology 207VX0201X CNP60357 Idaho

Profile Details

NPI number 1730652280
LBN Legal business name Larson, Brandy Lee
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 8th, 2019
Last updated Oct 31st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730652280 NPPES
Idaho MEDICAID 1730652280

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