Provider Demographics
NPI:1033538434
Name:GREEN, LAURA (R N)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 W 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2772
Mailing Address - Country:US
Mailing Address - Phone:303-587-5279
Mailing Address - Fax:
Practice Address - Street 1:3444 S EMERSON ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2834
Practice Address - Country:US
Practice Address - Phone:303-789-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0186629163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse