Individual
CLARISE LARGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN, CDCES, LDE
Contact information
Practice address
1331 STATE ST, LA PORTE, IN 46350-3112
(219) 325-7623
(219) 325-2665
Mailing address
1203 WASHINGTON ST, LA PORTE, IN 46350-3221
(219) 325-7623
(219) 326-2665
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
79000053A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79000053A
REGISTERED NURSE
IN
Enumeration date
01/18/2021
Last updated
01/18/2021
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