Healthcare Provider Details

I. General information

NPI: 1962647099
Provider Name (Legal Business Name): LAURIE DE LALIO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 W 84TH AVE
WESTMINSTER CO
80031-3807
US

IV. Provider business mailing address

2551 W 84TH AVE
WESTMINSTER CO
80031-3807
US

V. Phone/Fax

Practice location:
  • Phone: 303-561-5010
  • Fax: 303-561-5050
Mailing address:
  • Phone: 303-561-5010
  • Fax: 303-561-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0004466
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: