Provider Demographics
NPI:1073584538
Name:MATTHEWS, LAURA HELEN (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HELEN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6032
Mailing Address - Country:US
Mailing Address - Phone:203-748-6000
Mailing Address - Fax:203-748-6771
Practice Address - Street 1:CCWC PRACTICE GROUP
Practice Address - Street 2:94 LOCUST AVE
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-748-6000
Practice Address - Fax:203-748-6771
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV63369367A00000X
WV133367A00000X
PARN692919367A00000X
CT456367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721075OtherMS BCBS
WV7103174000Medicaid
WV7731468OtherAETNA
WV7731468OtherAETNA
2030603Medicare PIN
P97097Medicare UPIN
2030606Medicare PIN
2030605Medicare PIN
2030607Medicare PIN
2030604Medicare PIN
2030602Medicare PIN