Individual
LARISA G BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1675 W DEMPSTER ST, PARK RIDGE, IL 60068-1110
(847) 723-9470
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-2926
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.024855
IL
Other
Enumeration date
05/03/2022
Last updated
12/22/2022
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