Provider Demographics
NPI:1013187236
Name:LARSON HOYT, LISA E (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:LARSON HOYT
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2257
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2257
Mailing Address - Country:US
Mailing Address - Phone:208-525-2080
Mailing Address - Fax:208-525-2662
Practice Address - Street 1:555 EAST BROADWAY
Practice Address - Street 2:220
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-2790
Practice Address - Country:US
Practice Address - Phone:307-733-7222
Practice Address - Fax:307-733-9720
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10367.0054363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315839OtherBLUE CROSS OF WY