Healthcare Provider Details

I. General information

NPI: 1326647652
Provider Name (Legal Business Name): CRISTINA LAMMERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 02/24/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE AVE
FARIBAULT MN
55021-6319
US

IV. Provider business mailing address

2801 PURCELL ST
BRIGHTON CO
80601-3551
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-3300
  • Fax:
Mailing address:
  • Phone: 303-659-9700
  • Fax: 303-558-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0006463
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: