Healthcare Provider Details

I. General information

NPI: 1487434890
Provider Name (Legal Business Name): LAURA DUFFY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 N UNION BLVD STE 203
COLORADO SPRINGS CO
80918-1968
US

IV. Provider business mailing address

4111 STARGRASS DR
COLORADO SPRINGS CO
80918-4419
US

V. Phone/Fax

Practice location:
  • Phone: 719-237-8912
  • Fax: 719-249-9093
Mailing address:
  • Phone: 719-237-8912
  • Fax: 719-249-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: