Provider Demographics
NPI:1619200920
Name:NICHOLS, LAUREN HART (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HART
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:HART
Other - Last Name:DOWNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4820
Mailing Address - Fax:860-358-8661
Practice Address - Street 1:250 FLAT ROCK PL
Practice Address - Street 2:2ND FL
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1565
Practice Address - Country:US
Practice Address - Phone:860-358-3640
Practice Address - Fax:860-358-8656
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3863363AM0700X
CT002300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical