Provider Demographics
NPI:1689111858
Name:BARRIENTOS, LARRY (APN)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BARRIENTOS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 S KING RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8512
Mailing Address - Country:US
Mailing Address - Phone:708-941-5639
Mailing Address - Fax:
Practice Address - Street 1:1325 REMINGTON RD
Practice Address - Street 2:STE X
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4834
Practice Address - Country:US
Practice Address - Phone:630-237-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL452502430OtherTAX ID