Healthcare Provider Details

I. General information

NPI: 1083491526
Provider Name (Legal Business Name): CLARA MARION LARKIN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLARA MARION PARKER-LARKIN APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 COTTAGE GROVE AVE
FORD HEIGHTS IL
60411-3818
US

IV. Provider business mailing address

2751 TARPON CT
HOMEWOOD IL
60430-1425
US

V. Phone/Fax

Practice location:
  • Phone: 708-753-5800
  • Fax:
Mailing address:
  • Phone: 773-850-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.027623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: