Provider Demographics
NPI:1457469058
Name:KOOIENGA, LAURA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:KOOIENGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RAMPART WAY
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6440
Mailing Address - Country:US
Mailing Address - Phone:303-364-4775
Mailing Address - Fax:
Practice Address - Street 1:130 RAMPART WAY
Practice Address - Street 2:SUITE 300B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6440
Practice Address - Country:US
Practice Address - Phone:303-364-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41271207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology