Healthcare Provider Details

I. General information

NPI: 1861675092
Provider Name (Legal Business Name): LAURA A MAUGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 104TH AVE SUITE 115
THORNTON CO
80233-4404
US

IV. Provider business mailing address

2200 E 104TH AVE SUITE 115
THORNTON CO
80233-4404
US

V. Phone/Fax

Practice location:
  • Phone: 303-452-2766
  • Fax: 303-252-8694
Mailing address:
  • Phone: 303-452-2766
  • Fax: 303-252-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2528
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: