Provider Demographics
NPI:1528573441
Name:LARA O'NEIL APRN LLC
Entity Type:Organization
Organization Name:LARA O'NEIL APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC APRN
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:TRITTON
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-597-0110
Mailing Address - Street 1:60 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1828
Mailing Address - Country:US
Mailing Address - Phone:860-597-0110
Mailing Address - Fax:
Practice Address - Street 1:10 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4802
Practice Address - Country:US
Practice Address - Phone:860-200-8268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care