Healthcare Provider Details

I. General information

NPI: 1790405124
Provider Name (Legal Business Name): BROOKE LEIGH ANDERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 970-203-7250
  • Fax: 970-619-6094
Mailing address:
  • Phone: 970-624-2409
  • Fax: 970-490-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0008217
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: