Healthcare Provider Details

I. General information

NPI: 1033621545
Provider Name (Legal Business Name): LAURA ELIZABETH MACLUTSKY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

539 COMMERCIAL ST
PROVINCETOWN MA
02657-2412
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-3271
  • Fax: 508-856-5911
Mailing address:
  • Phone: 518-380-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2376552
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number644133
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11022290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: