Healthcare Provider Details

I. General information

NPI: 1801551650
Provider Name (Legal Business Name): LUIZA MCDONAGH APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STAPLES ST
DANBURY CT
06810-5323
US

IV. Provider business mailing address

137 DANBURY RD STE 154
NEW MILFORD CT
06776-3428
US

V. Phone/Fax

Practice location:
  • Phone: 475-204-1109
  • Fax:
Mailing address:
  • Phone: 475-204-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIZA MCDONAGH
Title or Position: OWNER
Credential: APRN, AGNP-C
Phone: 475-204-1109