Basic Information
| Provider Information | |||||||||
| NPI: | 1235416694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAYLOR | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7951 E MAPLEWOOD AVE STE 350 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039307895 | ||||||||
| FaxNumber: | 3032674477 | ||||||||
| Practice Location | |||||||||
| Address1: | 10107 RIDGEGATE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039250700 | ||||||||
| FaxNumber: | 3033292599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2011 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP990252 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 13474332 | 05 | CO | MEDICAID |