Provider Demographics
NPI:1922321355
Name:FOREST, LAURA CECILE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CECILE
Last Name:FOREST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CECILE
Other - Last Name:STOCKDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2365
Mailing Address - Country:US
Mailing Address - Phone:303-756-0101
Mailing Address - Fax:303-756-1408
Practice Address - Street 1:4900 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2365
Practice Address - Country:US
Practice Address - Phone:303-756-0101
Practice Address - Fax:303-756-1408
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant