Healthcare Provider Details

I. General information

NPI: 1811487945
Provider Name (Legal Business Name): LAURA GREMILLION LARGENT CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA KATHERINE GREMILLION

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 S PROMENADE BLVD STE 5185
ROGERS AR
72758-8722
US

IV. Provider business mailing address

333 S DESPLAINES ST STE 201
CHICAGO IL
60661-5514
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR091912
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: