John Larrison, APN, FNP-C

Individual provider Active NPI Family Nurse Practitioner · Metropolis, IL

NPI 1043663917 · NPPES record last updated Dec 19, 2018

Key facts

NPI
1043663917
Entity type
Individual (NPI type 1)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
209014310 (IL)
Practice address
28 Chick St Ste 100
Metropolis, IL 62960-2467
Phone
(618) 524-2176
Fax
(618) 524-4131
NPI assigned
Jul 15, 2016
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
209014310ILMDFamily Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209014310 IL Yes

Addresses

Primary practice location

28 Chick St Ste 100
Metropolis, IL 62960-2467

Mailing address

28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176

Other practice location 1

28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176 ext. 2382

Other practice location 2

1204 W 10th St
Metropolis, IL 62960-2433
Phone (618) 524-2176 ext. 2382

Other providers in Metropolis, IL

All providers in Metropolis, IL · Family Nurse Practitioner in Illinois

Sources for this page

Verify at the official NPI Registry.