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NPI Code Detail

MEDICARE: LAURIE B JANSON P. A.

MEDICARE: LAURIE B JANSON P. A.
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
1363A00000XPhysician AssistantPA17874CA
2363A00000XPhysician Assistant4012CO

General Provider Information

NPI Number : 1811130198
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE B JANSON P. A.
Provider Business Mailing Address
First Line : 2901 N CENTRAL AVE STE 160
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2702
Country : US
Telephone Number : 970-820-5000
Fax Number : 530-623-4397
Provider Business Practice Location Address
First Line : 2923 GINNALA DR
Second Line :
City : LOVELAND
State : CO
Zip : 80538-2702
Country : US
Telephone Number : 970-820-5000
Fax Number : 970-820-5061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2009
Last Update Date : 02/23/2023

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Directions to “ LAURIE B JANSON P. A.” Practice Location

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