1770966095 NPI number — MS. LAUREL HABINK BRANDON APRN

Table of content: MS. LAUREL HABINK BRANDON APRN (NPI 1770966095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770966095 NPI number — MS. LAUREL HABINK BRANDON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDON
Provider First Name:
LAUREL
Provider Middle Name:
HABINK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770966095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1952 WHITNEY AVE
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06517-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-776-4444
Provider Business Mailing Address Fax Number:
203-776-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1952 WHITNEY AVE
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06517-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-776-4444
Provider Business Practice Location Address Fax Number:
203-776-4441
Provider Enumeration Date:
07/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  6152 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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