Provider Demographics
NPI:1033708128
Name:LARIDE, CARMELINA (RPN)
Entity Type:Individual
Prefix:
First Name:CARMELINA
Middle Name:
Last Name:LARIDE
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S PFINGSTEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4934
Mailing Address - Country:US
Mailing Address - Phone:847-644-3628
Mailing Address - Fax:
Practice Address - Street 1:151 S PFINGSTEN RD STE B
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4934
Practice Address - Country:US
Practice Address - Phone:847-644-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.284874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse