MEDICARE: LORI MICHELLE STANDER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2668	CO

General Provider Information

NPI Number	:	1144558081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MICHELLE STANDER PA

Provider Business Mailing Address
First Line	:	6650 S VINE ST STE 100
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2740
Country	:	US
Telephone Number	:	303-953-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 S VINE ST STE 100
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2740
Country	:	US
Telephone Number	:	303-953-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	12/04/2009

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