Healthcare Provider Details

I. General information

NPI: 1700732880
Provider Name (Legal Business Name): LAURE LOUIS-CHARLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

IV. Provider business mailing address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-8910
  • Fax:
Mailing address:
  • Phone: 860-657-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.015494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: