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General NPI Number Information
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NPI Number | 1679396428
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Entity Type | Individual
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Provider Name | LAURA CECILIA MARTIN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 4575 BYRD DR
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City | LOVELAND
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State | CO
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Zip | 80538-7198
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Country | US
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Telephone | 970-593-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 585 N LINCOLN AVE APT 455
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City | LOVELAND
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State | CO
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Zip | 80537-5721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 924681
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License Number State | TX
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