Provider Demographics
NPI:1356003776
Name:LARSON, ALEXIS (NP-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 EAST HURON
Mailing Address - Street 2:GALTER PAVILION LC-178
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-926-2520
Mailing Address - Fax:312-926-6374
Practice Address - Street 1:251 EAST HURON
Practice Address - Street 2:GALTER PAVILION LC-178
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-2520
Practice Address - Fax:312-926-6374
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024018363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily