Provider Demographics
NPI:1417686833
Name:LARSEN, MADELINE ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:ROSE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9650 GROSS POINT RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:846-954-5787
Practice Address - Street 1:9650 GROSS POINT RD STE 2900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:846-954-5787
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085009052363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical