Provider Demographics
NPI:1407008899
Name:BROWN, LAURA VALLEE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:VALLEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:47 WIDEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2126
Mailing Address - Country:US
Mailing Address - Phone:719-390-4335
Mailing Address - Fax:719-390-4566
Practice Address - Street 1:47 WIDEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2126
Practice Address - Country:US
Practice Address - Phone:719-390-4335
Practice Address - Fax:719-390-4566
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical