Provider Demographics
NPI:1083688535
Name:SANDERS, LAURA J (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 KIPLING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-3923
Mailing Address - Country:US
Mailing Address - Phone:303-425-0500
Mailing Address - Fax:303-425-1009
Practice Address - Street 1:7950 KIPLING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3923
Practice Address - Country:US
Practice Address - Phone:303-425-0500
Practice Address - Fax:303-425-1009
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q54879Medicare UPIN
803728Medicare ID - Type Unspecified