Individual
LAURA MARIE WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, PA-C
Contact information
Practice address
1030 JOHNSON RD STE 200, GOLDEN, CO 80401-6007
(303) 278-4600
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(303) 763-4900
(303) 763-5495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3963
CO
363A00000X
Physician Assistant
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.0003963
PHYSICIAN ASSISTANT LICENSE
CO
Enumeration date
05/29/2013
Last updated
06/16/2025
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