Provider Demographics
NPI:1770831380
Name:AMEDRO, LAURA N (MSN FNP BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:AMEDRO
Suffix:
Gender:F
Credentials:MSN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4250
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4250
Mailing Address - Country:US
Mailing Address - Phone:970-668-1616
Mailing Address - Fax:970-668-5650
Practice Address - Street 1:730 N SUMMIT BLVD
Practice Address - Street 2:STE 101
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1616
Practice Address - Fax:970-668-5650
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56006578Medicaid
CO56006578Medicaid