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General NPI Number Information
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NPI Number | 1023260098
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Entity Type | Individual
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Provider Name | GARY LEE LARSON RN
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Gender | Male
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | UNIT 45013 USAG-J, BOX 3257
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City | APO
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State | AP
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Zip | 96338-5013
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Country | US
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Telephone | 315-263-4016
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 45013 USAG-J, BOX 3257
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City | APO
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State | AP
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Zip | 96338-5013
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Country | US
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Telephone | 315-263-4016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | R017398
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License Number State | SD
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