Larson, Mary Kay

Larson, Mary Kay is an individual health care provider with primary practice located at 4405 Weaver Pkwy , Warrenville IL 60555-3269. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Larson, Mary Kay can be contacted via phone (630) 352-5450.

Contact Information

Primary practice address
4405 Weaver Pkwy Warrenville IL 60555-3269
Phone: (630) 352-5450
Fax: (630) 352-5499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209006678 Illinois

Profile Details

NPI number 1124293691
LBN Legal business name Larson, Mary Kay
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2008
Last updated Apr 22nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124293691 NPPES
Illinois Other 206147214 MEDICARE PTAN (INDIVIDUAL)

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