Healthcare Provider Details

I. General information

NPI: 1356328454
Provider Name (Legal Business Name): LORI L JAPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 INTEGRITY CENTER PT
COLORADO SPRINGS CO
80917-1683
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-591-2558
  • Fax: 719-591-2596
Mailing address:
  • Phone: 970-624-4036
  • Fax: 970-490-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1639
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0001639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: