Healthcare Provider Details

I. General information

NPI: 1003388919
Provider Name (Legal Business Name): LAURA ELIZABETH GABRIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH GINN APRN

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

IV. Provider business mailing address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 860-777-5829
  • Fax:
Mailing address:
  • Phone: 860-777-5829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN10001099
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8017
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: