Provider Demographics
NPI:1578875845
Name:VENNER, LAURA ANN (DPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:VENNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:WETSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2478 PATTERSON RD
Mailing Address - Street 2:UNIT1
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-3605
Mailing Address - Country:US
Mailing Address - Phone:970-245-3338
Mailing Address - Fax:
Practice Address - Street 1:2478 PATTERSON RD
Practice Address - Street 2:UNIT 1
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3605
Practice Address - Country:US
Practice Address - Phone:970-245-3338
Practice Address - Fax:970-245-9499
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO724213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program