Healthcare Provider Details

I. General information

NPI: 1619481595
Provider Name (Legal Business Name): STEVEN MICHAEL LAMOUREUX APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE STE 3
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

86 KNOLLWOOD RD
FARMINGTON CT
06032-1029
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone: 860-404-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number007282
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: