Provider Demographics
NPI:1710967864
Name:SHOVELTON, LAWRENCE M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:M
Last Name:SHOVELTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8719
Mailing Address - Country:US
Mailing Address - Phone:719-657-4102
Mailing Address - Fax:719-657-4106
Practice Address - Street 1:29 SILVER SPRUCE DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9483
Practice Address - Country:US
Practice Address - Phone:719-325-6871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30437873Medicaid
CO4702OtherCRNA
COCOA101353Medicare UPIN
COCO301340Medicare Oscar/Certification