Provider Demographics
NPI:1366675688
Name:CONROY, LAURYN M (APRN)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:M
Last Name:CONROY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAURYN
Other - Middle Name:M
Other - Last Name:BULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:136 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3723
Mailing Address - Country:US
Mailing Address - Phone:860-725-0171
Mailing Address - Fax:860-725-0191
Practice Address - Street 1:136 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3723
Practice Address - Country:US
Practice Address - Phone:860-725-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008007959Medicaid
CT008007959Medicaid