Provider Demographics
NPI:1386693802
Name:NANKEY, LAUREL MARIE (P A)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:MARIE
Last Name:NANKEY
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:720-738-1122
Mailing Address - Fax:720-738-1139
Practice Address - Street 1:10120 E DRY CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-2772
Practice Address - Country:US
Practice Address - Phone:720-738-1122
Practice Address - Fax:720-738-1139
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65876750Medicaid
CO65876750Medicaid
COC177288Medicare PIN