Provider Demographics
NPI:1598304438
Name:MARTIN, LAURA LEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1432
Mailing Address - Country:US
Mailing Address - Phone:719-852-2512
Mailing Address - Fax:
Practice Address - Street 1:925 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1432
Practice Address - Country:US
Practice Address - Phone:719-852-2512
Practice Address - Fax:719-852-3923
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995242-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily