Provider Demographics
NPI:1174974661
Name:LARSEN, GLADYS (FNP)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:7901 W 159TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1881
Mailing Address - Country:US
Mailing Address - Phone:312-279-9814
Mailing Address - Fax:
Practice Address - Street 1:7901 W 159TH ST STE B
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1881
Practice Address - Country:US
Practice Address - Phone:312-279-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.001014363L00000X
IL277001014363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health