Healthcare Provider Details

I. General information

NPI: 1497622179
Provider Name (Legal Business Name): RENEE DELA CHEVROTIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE LECLERC

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W MAIN ST
AVON CT
06001-4322
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2150
  • Fax:
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15799
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: