Healthcare Provider Details

I. General information

NPI: 1760495881
Provider Name (Legal Business Name): CHERYL LAFLAMME APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 QUAKER LN S
WEST HARTFORD CT
06110-1026
US

IV. Provider business mailing address

3 FARM GLEN BLVD PROHEALTH PHYSICIANS
FARMINGTON CT
06032-1981
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-5133
  • Fax: 860-233-5212
Mailing address:
  • Phone: 860-284-5200
  • Fax: 860-284-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001947
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number001947
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: