Healthcare Provider Details

I. General information

NPI: 1811368194
Provider Name (Legal Business Name): LAUREN BRENNAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 09/29/2022
Certification Date:
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: 860-679-4100
  • Fax: 860-679-1064
Mailing address:
  • Phone: 860-679-4100
  • Fax: 860-679-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6330
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: