Provider Demographics
NPI:1841556016
Name:DANIS, LAUREN C (NP-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:DANIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PART STREET APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5439
Mailing Address - Country:US
Mailing Address - Phone:757-709-9966
Mailing Address - Fax:
Practice Address - Street 1:111 PARK ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5439
Practice Address - Country:US
Practice Address - Phone:757-709-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT117537163W00000X
CT5705363LA2200X
VA0024169905363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400140418Medicare PIN