Provider Demographics
NPI:1043538283
Name:LAUTENBACH, MARY E (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:LAUTENBACH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:9777 S YOSEMITE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3191
Mailing Address - Country:US
Mailing Address - Phone:303-803-1000
Mailing Address - Fax:720-475-8484
Practice Address - Street 1:9777 S YOSEMITE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3191
Practice Address - Country:US
Practice Address - Phone:303-803-1000
Practice Address - Fax:720-475-8484
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CONP5695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner