Provider Demographics
NPI:1356633085
Name:LONGWELL, LAURA LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEE
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:
Practice Address - Street 1:6615 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1809
Practice Address - Country:US
Practice Address - Phone:719-364-9494
Practice Address - Fax:719-364-9761
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG154867207R00000X
ORDO169510207R00000X
CODR.0059503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine