Healthcare Provider Details

I. General information

NPI: 1710460316
Provider Name (Legal Business Name): LAURA GREENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W HAMPDEN AVE UNIT 103
ENGLEWOOD CO
80110-7330
US

IV. Provider business mailing address

5600 S QUEBEC ST STE 312A
GREENWOOD VILLAGE CO
80111-2208
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-1699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: