Provider Demographics
NPI:1497314397
Name:LARRIEU, MARCUS (APN)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:LARRIEU
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:
Other - Last Name:LARRIEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:2922 IMPERIAL CT
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2210
Mailing Address - Country:US
Mailing Address - Phone:773-318-8286
Mailing Address - Fax:
Practice Address - Street 1:10837 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6458
Practice Address - Country:US
Practice Address - Phone:773-636-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner