Healthcare Provider Details

I. General information

NPI: 1346016540
Provider Name (Legal Business Name): LOURDES DULUC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

36 ROBERT ST
HAMDEN CT
06514-3018
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13592
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number168510
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: