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General NPI Number Information
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NPI Number | 1528573441
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Entity Type | Organization
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Legal Business Name | LARA O'NEIL APRN LLC
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 10 COMMERCE ST STE A
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City | GLASTONBURY
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State | CT
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Zip | 06033-4802
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Country | US
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Telephone | 860-200-8268
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Fax |
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Provider Business Mailing Address
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Address Line | 60 NOTT ST
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City | WETHERSFIELD
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State | CT
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Zip | 06109-1828
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Country | US
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Telephone | 860-597-0110
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC APRN
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Name | LARA TRITTON O'NEIL
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Credential | APRN
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Telephone | 860-597-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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