MEDICARE: LAURA MARIA CHAVEZ BALCH

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	0999764	CO
2	363LN0000X	Neonatal Nurse Practitioner	APN.0999764-NP	CO

General Provider Information

NPI Number	:	1780424531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIA CHAVEZ BALCH

Provider Business Mailing Address
First Line	:	227 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3531
Country	:	US
Telephone Number	:	847-641-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3531
Country	:	US
Telephone Number	:	847-641-1131
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	04/14/2026

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