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Individual

MRS. LACEY BRYN LUNEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 963-6486
Mailing address
94 S MAIN ST, FL 1, PUTNAM, CT 06260-1908
(802) 734-8824

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002398
CT
363AM0700X
Medical Physician Assistant
Primary
002398
CT

Other

Enumeration date
05/11/2010
Last updated
10/16/2014
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