1861785032 NPI number — MRS. SHARON E. LARSEN DNP - APN

Table of content: MRS. SHARON E. LARSEN DNP - APN (NPI 1861785032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861785032 NPI number — MRS. SHARON E. LARSEN DNP - APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSEN
Provider First Name:
SHARON
Provider Middle Name:
E.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP - APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861785032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 ESTHER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60014-6140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-405-2210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 N TERRA COTTA RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60012-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-459-7127
Provider Business Practice Location Address Fax Number:
833-944-2257
Provider Enumeration Date:
05/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  277.000073 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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