Healthcare Provider Details

I. General information

NPI: 1659617579
Provider Name (Legal Business Name): LAURA MCEWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BETZ

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCONN MEDICAL GROUP 263 FARMINGTON AVENUE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

UCONN MEDICAL GROUP 263 FARMINGTON AVENUE
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2792
  • Fax: 860-679-1494
Mailing address:
  • Phone: 860-679-2792
  • Fax: 860-679-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number007053
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number007053
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: