MEDICARE: HOLLY LAUGHLIN REGISTERED NURSE

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	163W00000X	Registered Nurse	1656137	CO

General Provider Information

NPI Number	:	1902413776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY LAUGHLIN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	1024 W BROKEN BOW DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-4094
Country	:	US
Telephone Number	:	720-466-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 W BROKEN BOW DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-4094
Country	:	US
Telephone Number	:	720-466-0212
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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