Provider Demographics
NPI:1760669535
Name:LOURENCO, NATALIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:LOURENCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-687-6626
Mailing Address - Fax:203-737-4051
Practice Address - Street 1:135 COLLEGE ST
Practice Address - Street 2:STE 323
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2483
Practice Address - Country:US
Practice Address - Phone:203-687-6626
Practice Address - Fax:203-737-4051
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001186363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical