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General NPI Number Information
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NPI Number | 1639987779
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Entity Type | Individual
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Provider Name | CHANDLER CREECH LARSEN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1076 MARLBORO WAY STE 3
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-2495
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Country | US
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Telephone | 843-479-0432
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Fax |
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Provider Business Mailing Address
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Address Line | 605 LAKESHORE DR
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-2515
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Country | US
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Telephone | 843-439-3575
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29776
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License Number State | SC
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