Healthcare Provider Details

I. General information

NPI: 1396304705
Provider Name (Legal Business Name): LAURA ROSENHAHN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7815
US

IV. Provider business mailing address

5160 LANAGAN ST
COLORADO SPRINGS CO
80919-3557
US

V. Phone/Fax

Practice location:
  • Phone: 719-305-1234
  • Fax:
Mailing address:
  • Phone: 719-494-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1617496
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994497-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: