Provider Demographics
NPI:1639987779
Name:LARSEN, CHANDLER CREECH (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:CREECH
Last Name:LARSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2515
Mailing Address - Country:US
Mailing Address - Phone:843-439-3575
Mailing Address - Fax:
Practice Address - Street 1:1076 MARLBORO WAY STE 3
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2495
Practice Address - Country:US
Practice Address - Phone:843-479-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily