Healthcare Provider Details

I. General information

NPI: 1508544909
Provider Name (Legal Business Name): JOANA B LAUTURE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 WEST ST
DANBURY CT
06810-3308
US

IV. Provider business mailing address

15 DRYDEN ST
STAMFORD CT
06902-4609
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-5005
  • Fax:
Mailing address:
  • Phone: 203-550-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11999
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: