Provider Demographics
NPI:1881724110
Name:DRYSDALE, LAUREN E (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:DRYSDALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W BROAD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3661
Mailing Address - Country:US
Mailing Address - Phone:203-276-4404
Mailing Address - Fax:203-276-4405
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-276-4404
Practice Address - Fax:203-276-4405
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003371363L00000X
NYF304189363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT38840OtherDEP OF CONSUMER PROTECTIO
CT3371OtherCT APRN LICENSURE
CT3371OtherCT APRN LICENSURE