Healthcare Provider Details

I. General information

NPI: 1538459847
Provider Name (Legal Business Name): LAKEN RENEE EYLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OTTLEY AVE
FRUITA CO
81521-2118
US

IV. Provider business mailing address

627 25 1/2 RD
GRAND JUNCTION CO
81505-6401
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2705
  • Fax:
Mailing address:
  • Phone: 970-242-3535
  • Fax: 970-623-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3192
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: