MEDICARE: LAURA FADIL MOORE CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	160465	CO
2	363L00000X	Nurse Practitioner	APN.0990111-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386663102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FADIL MOORE CNP

Provider Business Mailing Address
First Line	:	281 SAWYER DR STE 100
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81303-3409
Country	:	US
Telephone Number	:	970-769-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 MAIN AVE
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-4638
Country	:	US
Telephone Number	:	970-259-1630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/09/2026

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