Provider Demographics
NPI:1417147620
Name:CIESLIK, LAURA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:CIESLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 LINCOLN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3290
Mailing Address - Country:US
Mailing Address - Phone:970-542-0390
Mailing Address - Fax:970-542-0394
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-542-0390
Practice Address - Fax:970-542-0394
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146599207V00000X
WAMD61043294207V00000X, 208M00000X
CODR-50334207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2171001Medicaid