Provider Demographics
NPI:1861785032
Name:LARSEN, SHARON E (DNP - APN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:E
Last Name:LARSEN
Suffix:
Gender:F
Credentials:DNP - APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:815-405-2210
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:833-944-2257
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000073363LF0000X
IL209.008840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008840OtherSTATE LICENSE