Provider Demographics
NPI:1609008796
Name:MCMAHON, LAURA ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4020 JERRY MURPHY RD.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-546-3600
Mailing Address - Fax:719-546-0931
Practice Address - Street 1:4020 JERRY MURPHY RD/
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-546-3600
Practice Address - Fax:719-546-0931
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-10045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily