Healthcare Provider Details

I. General information

NPI: 1780910877
Provider Name (Legal Business Name): ANDREA YVONNE PLEUNE PA-C, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA YVONNE JOHNSON PA-C, MS

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STEELE ST
DENVER CO
80206-4479
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-372-4010
  • Fax:
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0002909
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0002909
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: