Healthcare Provider Details

I. General information

NPI: 1730783226
Provider Name (Legal Business Name): LAURA BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

IV. Provider business mailing address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-9703
  • Fax: 877-588-3465
Mailing address:
  • Phone: 719-373-9703
  • Fax: 877-588-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010215
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0100785-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: