Healthcare Provider Details

I. General information

NPI: 1003123985
Provider Name (Legal Business Name): LAURA K DEGEORGE APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR
TRUMBULL CT
06611-6337
US

IV. Provider business mailing address

124 CEDAR LN
BEACON FALLS CT
06403-1214
US

V. Phone/Fax

Practice location:
  • Phone: 203-445-7093
  • Fax: 203-638-7981
Mailing address:
  • Phone: 203-228-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004467
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: