NPI 1245671379

Tucker Lloyd Larsen, PAC

Practitioner Physician Assistant Plummer, ID

Practice location

Address: 427 N 12th St., Plummer, ID 83851
Phone: (208) 686-1931
Mailing address: PO Box 388, Plummer, ID 83851-0388

Registered specialties (3)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-1457 (ID)

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Mental Health Counselor

Behavioral Health & Social Service Providers Taxonomy 101YM0800X

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1245671379
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 Jul 2013
Record last updated: 8 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.