Provider Demographics
NPI:1194432716
Name:EDSALL, LARALEE (RN)
Entity type:Individual
Prefix:
First Name:LARALEE
Middle Name:
Last Name:EDSALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COURTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-3946
Mailing Address - Country:US
Mailing Address - Phone:208-993-0618
Mailing Address - Fax:
Practice Address - Street 1:315 COURTHOUSE DR
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-3946
Practice Address - Country:US
Practice Address - Phone:208-993-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID33706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse