Healthcare Provider Details

I. General information

NPI: 1073584538
Provider Name (Legal Business Name): LAURA HELEN MATTHEWS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CCWC PRACTICE GROUP 94 LOCUST AVE
DANBURY CT
06810
US

IV. Provider business mailing address

94 LOCUST AVE
DANBURY CT
06810-6032
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-6000
  • Fax: 203-748-6771
Mailing address:
  • Phone: 203-748-6000
  • Fax: 203-748-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number63369
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number133
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN692919
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number456
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: