Provider Demographics
NPI:1760727010
Name:PITON, LARISA (APN)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:PITON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N. ROCKTON AVE.
Mailing Address - Street 2:PAIN MANAGEMENT DEPT
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3655
Mailing Address - Country:US
Mailing Address - Phone:815-971-5000
Mailing Address - Fax:815-968-9677
Practice Address - Street 1:2400 N. ROCKTON AVE.
Practice Address - Street 2:PAIN MANAGEMENT DEPT
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-5000
Practice Address - Fax:815-968-9677
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041356380363LA2100X
IL209009823363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care