Healthcare Provider Details

I. General information

NPI: 1285164293
Provider Name (Legal Business Name): LAURA SCIBELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CRANBROOK BLVD
ENFIELD CT
06082
US

IV. Provider business mailing address

9 CRANBROOK BLVD
ENFIELD CT
06082-3889
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-5330
  • Fax: 860-253-5331
Mailing address:
  • Phone: 860-253-5330
  • Fax: 860-253-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number11039859
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number007220
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: