Provider Demographics
NPI:1417498213
Name:MILLER, LAURA A (AGNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL STE 450
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1719
Mailing Address - Country:US
Mailing Address - Phone:303-825-1234
Mailing Address - Fax:720-321-8121
Practice Address - Street 1:11700 W 2ND PL STE 450
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1719
Practice Address - Country:US
Practice Address - Phone:303-825-1234
Practice Address - Fax:720-321-8121
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992974-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000146137Medicaid