Provider Demographics
NPI:1184764243
Name:LARSON, ERIKA KRISTEN (MED)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:KRISTEN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 N HONORE ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1794
Mailing Address - Country:US
Mailing Address - Phone:773-680-7082
Mailing Address - Fax:
Practice Address - Street 1:7313 N HONORE ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1794
Practice Address - Country:US
Practice Address - Phone:773-680-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist