Healthcare Provider Details

I. General information

NPI: 1497165559
Provider Name (Legal Business Name): LAUREN JEAN ELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 E FLORIDA AVE STE 200
DENVER CO
80222-3641
US

IV. Provider business mailing address

4105 E FLORIDA AVE STE 200
DENVER CO
80222-3641
US

V. Phone/Fax

Practice location:
  • Phone: 303-539-0736
  • Fax: 303-539-0737
Mailing address:
  • Phone: 303-539-0736
  • Fax: 303-539-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0005097
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: