Individual
LAURA DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
333 COURT ST, PUEBLO, CO 81003-3231
(719) 994-0769
Mailing address
673 S BOND DR E, PUEBLO WEST, CO 81007-1576
(719) 994-0769
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0014506
CO
Other
Enumeration date
09/08/2014
Last updated
09/08/2014
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