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General NPI Number Information
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NPI Number | 1053729020
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Entity Type | Individual
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Provider Name | ELISSA MARIE LARKIN APN, CNM
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 09/27/2014
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Provider Practice Location Address
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Address Line | 2311 S BONNIE BROOK LN
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City | WAUKEGAN
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State | IL
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Zip | 60087-3721
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Country | US
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Telephone | 831-264-3771
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Fax | 888-959-0674
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Provider Business Mailing Address
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Address Line | 2311 S BONNIE BROOK LN
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City | WAUKEGAN
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State | IL
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Zip | 60087-3721
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Country | US
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Telephone | 831-264-3771
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Fax | 888-959-0674
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041421123
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 148897-32
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 209011894
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License Number State | IL
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