Healthcare Provider Details

I. General information

NPI: 1366113474
Provider Name (Legal Business Name): LAURA MOORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 RIDGEGATE PKWY STE 200
LONE TREE CO
80124-5641
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 350
GREENWOOD VILLAGE CO
80111-4758
US

V. Phone/Fax

Practice location:
  • Phone: 303-925-0700
  • Fax: 303-329-2599
Mailing address:
  • Phone: 303-930-7895
  • Fax: 832-601-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996874-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1676642
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: