Basic Information
| Provider Information | |||||||||
| NPI: | 1508197906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARKIN | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | LUANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6730 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852466730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808213600 | ||||||||
| FaxNumber: | 4808213610 | ||||||||
| Practice Location | |||||||||
| Address1: | 10238 E HAMPTON AVE | ||||||||
| Address2: | STE 507 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808213600 | ||||||||
| FaxNumber: | 4808572667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2010 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | RN120827 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | LAR104351260 | 01 | AZ | NCC | OTHER | ML2140630 | 01 | AZ | DEA | OTHER | 506659 | 05 | AZ | MEDICAID |