Provider Demographics
NPI:1487434890
Name:DUFFY, LAURA (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 STARGRASS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4419
Mailing Address - Country:US
Mailing Address - Phone:719-237-8912
Mailing Address - Fax:719-249-9093
Practice Address - Street 1:5525 N UNION BLVD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1968
Practice Address - Country:US
Practice Address - Phone:719-237-8912
Practice Address - Fax:719-249-9093
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist