Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0995643 | CO |
NPI | 1023581139 |
---|---|
Provider Name | Laura Mae Smith |
First Address | Wheat Ridge, CO 80033-6715 |
Second Address | Wheat Ridge, CO 80033-6715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 20/07/2020 |