Provider Demographics
NPI:1285164293
Name:SCIBELLI, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SCIBELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRANBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3889
Mailing Address - Country:US
Mailing Address - Phone:860-253-5330
Mailing Address - Fax:860-253-5331
Practice Address - Street 1:9 CRANBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-253-5330
Practice Address - Fax:860-253-5331
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11039859163WX0800X
390200000X
CT007220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program