Larisa G Basa
Nurse Practitioner, Family in Park Ridge, IL. Individual provider (NPI-1).
NPI number1336884493
StatusActive
Last updated in NPPESDec 22, 2022
Details
- NPI
- 1336884493
- Entity type
- Individual (NPI-1)
- Name
- Larisa G Basa
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 3, 2022
- Certification date
- Dec 22, 2022
- Last updated
- Dec 22, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209.024855 | IL | Yes |
Practice location
1675 W Dempster StPark Ridge, IL 60068-1110
Phone 847-723-9470
Mailing address
29373 Network PlChicago, IL 60673-2926
Phone 847-390-5900
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