Provider Demographics
NPI:1053963058
Name:REASONER, LARK LAUREN (MD)
Entity type:Individual
Prefix:
First Name:LARK
Middle Name:LAUREN
Last Name:REASONER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:LAUREN
Other - Last Name:MEINERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:830 LADY BUG LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9005
Mailing Address - Country:US
Mailing Address - Phone:815-814-7434
Mailing Address - Fax:
Practice Address - Street 1:3051 CAHILL MAIN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7109
Practice Address - Country:US
Practice Address - Phone:608-661-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE84702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry