Provider Demographics
NPI:1629628821
Name:BOX, LAURA MICHELLE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:BOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 COTTONTAIL DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6012
Mailing Address - Country:US
Mailing Address - Phone:719-683-6059
Mailing Address - Fax:
Practice Address - Street 1:13360 COTTONTAIL DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6012
Practice Address - Country:US
Practice Address - Phone:719-683-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider