Healthcare Provider Details

I. General information

NPI: 1225307598
Provider Name (Legal Business Name): BRIAN F LACOMBE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

165 OCTOBER LN
PLANTSVILLE CT
06479-1018
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6654
  • Fax:
Mailing address:
  • Phone: 860-877-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number87820
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: