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General NPI Number Information
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NPI Number | 1336403203
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Entity Type | Individual
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Provider Name | LARSEN HARRIS PETERSON CD(DONA),
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 1541 N 2ND AVE
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City | HAILEY
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State | ID
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Zip | 83333-8629
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Country | US
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Telephone | 208-720-4338
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4172
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City | KETCHUM
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State | ID
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Zip | 83340-4172
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Country | US
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Telephone | 208-720-4338
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | ID
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