Provider Demographics
NPI:1235344581
Name:PARKER, LAURA (RN, CNP, CDE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, CNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BURNETT CT
Mailing Address - Street 2:SUITE 100 AND 200
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3647
Mailing Address - Country:US
Mailing Address - Phone:970-385-4022
Mailing Address - Fax:
Practice Address - Street 1:2 BURNETT CT
Practice Address - Street 2:SUITE 100 AND 200
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3647
Practice Address - Country:US
Practice Address - Phone:970-385-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR29347163W00000X
NMCNP-01704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45675341Medicaid
NMPENDINGMedicare ID - Type Unspecified
NM45675341Medicaid