Healthcare Provider Details

I. General information

NPI: 1376351999
Provider Name (Legal Business Name): LAUREN ELIZABETH BONNETTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SALISBURY ST
WORCESTER MA
01609-1265
US

IV. Provider business mailing address

32 BLACKTHORN DR
WORCESTER MA
01609-1192
US

V. Phone/Fax

Practice location:
  • Phone: 508-425-9407
  • Fax:
Mailing address:
  • Phone: 508-425-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2344944
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: