MEDICARE: MS. LAURA GREMILLION LARGENT CNM, WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	R091912	AR

General Provider Information

NPI Number	:	1811487945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA GREMILLION LARGENT CNM, WHNP

Provider Business Mailing Address
First Line	:	333 S DESPLAINES ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 S PROMENADE BLVD STE 5185
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8722
Country	:	US
Telephone Number	:	479-480-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/20/2024

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