Healthcare Provider Details

I. General information

NPI: 1396389474
Provider Name (Legal Business Name): MS. LAUREN CARLINO-BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

101 WASHINGTON BLVD UNIT 624
STAMFORD CT
06902-6862
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number644495
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number129265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: