Healthcare Provider Details

I. General information

NPI: 1710330642
Provider Name (Legal Business Name): LARA MARIE HELENA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

2500 S HAVANA ST
AURORA CO
80014-1618
US

V. Phone/Fax

Practice location:
  • Phone: 303-748-8153
  • Fax:
Mailing address:
  • Phone: 303-748-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1619515
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: