Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 20A12038 | CA |
N | 208600000X | Surgeon | 20A12038 | CA |
N | 208200000X | Surgeon | 34-011701 | OH |
N | 208600000X | Surgeon | 34-011701 | OH |
Y | 208200000X | Surgeon | DR.0056590 | CO |
Y | 208600000X | Surgeon | DR.0056590 | CO |
NPI | 1003116526 |
---|---|
Provider Name | Laura Hafertepen |
First Address | Greenwood Village, CO 80111-2803 |
Second Address | Greenwood Village, CO 80111-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 22/10/2021 |