Provider Demographics
NPI:1700205382
Name:LARSON, STEPHEN NATHANIEL (DVM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NATHANIEL
Last Name:LARSON
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2800
Mailing Address - Country:US
Mailing Address - Phone:708-749-4200
Mailing Address - Fax:708-749-4269
Practice Address - Street 1:2845 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2800
Practice Address - Country:US
Practice Address - Phone:708-749-4200
Practice Address - Fax:708-749-4269
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090-006654174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian