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General NPI Number Information
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NPI Number | 1225334766
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Entity Type | Individual
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Provider Name | CANDACE LEIGH BROMLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 2500 ROCKY MOUNTAIN AVE STE 360
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City | LOVELAND
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State | CO
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Zip | 80538-9004
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Country | US
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Telephone | 970-221-1000
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Fax | 970-624-1892
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Provider Business Mailing Address
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Address Line | 2500 ROCKY MOUNTAIN AVE STE 360
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City | LOVELAND
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State | CO
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Zip | 80538-9004
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Country | US
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Telephone | 970-221-1000
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Fax | 970-624-1892
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00449400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA054798
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006588
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License Number State | CO
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