Healthcare Provider Details

I. General information

NPI: 1528540069
Provider Name (Legal Business Name): LANCE R ANDREASEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR STE 100
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

4102 PINION DR STE 100
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-524-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3638539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3638539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: