MEDICARE: LAURA MICHELLE FREDERICK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1600X	Continuing Education/Staff Development Registered Nurse	0167824	CO
2	163WM0102X	Maternal Newborn Registered Nurse	0167824	CO
3	163WX0003X	Inpatient Obstetric Registered Nurse	0167824	CO
4	163W00000X	Registered Nurse	0167824	CO

General Provider Information

NPI Number	:	1902305204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MICHELLE FREDERICK RN

Provider Business Mailing Address
First Line	:	5255 MEMPHIS ST UNIT 1109
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5253
Country	:	US
Telephone Number	:	720-884-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 MEMPHIS ST UNIT 1109
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5253
Country	:	US
Telephone Number	:	720-884-6005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	02/02/2018

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