Individual
LAURA MARIE GRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-8083
(860) 679-8080
(860) 679-1340
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-8082
(860) 679-8080
(860) 679-1340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003042
CT
363AM0700X
Medical Physician Assistant
003042
CT
363AS0400X
Surgical Physician Assistant
Primary
003042
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003030426
—
CT
Enumeration date
12/30/2013
Last updated
09/28/2022
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