Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 004467 | CT |
NPI | 1003123985 |
---|---|
Provider Name | Mrs. Laura K Degeorge |
First Address | Beacon Falls, CT 06403-1214 |
Second Address | Trumbull, CT 06611-6337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 04/05/2020 |