MEDICARE: MRS. LAURA ELIZABETH GABRIEL APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN10001099	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	8017	CT

General Provider Information

NPI Number	:	1003388919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ELIZABETH GABRIEL APRN

Provider Business Mailing Address
First Line	:	2389 MAIN ST STE 100
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4617
Country	:	US
Telephone Number	:	860-777-5829
Fax Number	:

Provider Business Practice Location Address
First Line	:	2389 MAIN ST STE 100
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4617
Country	:	US
Telephone Number	:	860-777-5829
Fax Number	:

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	04/09/2026

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