Healthcare Provider Details

I. General information

NPI: 1184218497
Provider Name (Legal Business Name): LAUREN GRIPP ELYSEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN GRIPP FNP

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W MAIN ST STE 220
STAMFORD CT
06902-4542
US

IV. Provider business mailing address

901 MCCLINTOCK DR STE 202
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6432
  • Fax:
Mailing address:
  • Phone: 888-220-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346828
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: