Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 4526 | CO |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4526 | CO |
NPI | 1083929384 |
---|---|
Provider Name | Laura Jeanne Clevenger |
First Address | Aurora, CO 80045-7106 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 03/09/2010 |