Provider Demographics
NPI:1760956726
Name:CARDINALIGHT HEALTH, LLC
Entity Type:Organization
Organization Name:CARDINALIGHT HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN
Authorized Official - Phone:815-459-7127
Mailing Address - Street 1:70 ESTHER ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6140
Mailing Address - Country:US
Mailing Address - Phone:815-459-7127
Mailing Address - Fax:
Practice Address - Street 1:380 N TERRA COTTA RD STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1809
Practice Address - Country:US
Practice Address - Phone:815-459-7127
Practice Address - Fax:949-404-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.008840OtherAPN STATE LICENSE