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General NPI Number Information
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NPI Number | 1730130337
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Entity Type | Individual
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Provider Name | LAURA C KISSELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST STE 600
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-364-6487
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Fax | 719-364-8347
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 44538
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 200400694
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License Number State | NC
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