Provider Demographics
NPI:1851538433
Name:LARSEN, CHRISTOPHER D (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:LARSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9788
Mailing Address - Country:US
Mailing Address - Phone:630-885-2415
Mailing Address - Fax:
Practice Address - Street 1:198 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9788
Practice Address - Country:US
Practice Address - Phone:630-885-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041277056163W00000X, 163WA2000X, 163WC0200X, 163WE0003X, 163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience