Provider Demographics
NPI:1558950170
Name:LARGEN, CLARISE (BSN, RN, CDCES, LDE)
Entity Type:Individual
Prefix:
First Name:CLARISE
Middle Name:
Last Name:LARGEN
Suffix:
Gender:F
Credentials:BSN, RN, CDCES, LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3221
Mailing Address - Country:US
Mailing Address - Phone:219-325-7623
Mailing Address - Fax:219-326-2665
Practice Address - Street 1:1331 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3112
Practice Address - Country:US
Practice Address - Phone:219-325-7623
Practice Address - Fax:219-325-2665
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN79000053A163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN79000053AOtherREGISTERED NURSE