Provider Demographics
NPI:1588189260
Name:SCHULZE, LARISSA MARIE (DNP, APN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MARIE
Last Name:SCHULZE
Suffix:
Gender:F
Credentials:DNP, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W JACKSON BLVD APT 411
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5619
Mailing Address - Country:US
Mailing Address - Phone:319-721-9513
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 820
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6659
Practice Address - Country:US
Practice Address - Phone:312-202-0300
Practice Address - Fax:312-202-0383
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016168363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics