Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209.021596 | IL |
NPI | 1013076702 |
---|---|
Provider Name | Becky Largent |
First Address | Bloomington, IL 61704 |
Second Address | Normal, IL 61761-6286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 14/08/2020 |