Provider Demographics
NPI:1083689731
Name:COLANDER, LORA LEE (PA C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEE
Last Name:COLANDER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:LEE
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1390 CHAMBERS RD
Mailing Address - Street 2:MILE HIGH PRIMARY CARE PC
Mailing Address - City:AUROROA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:303-341-4200
Mailing Address - Fax:303-341-4480
Practice Address - Street 1:1390 CHAMBERS RD
Practice Address - Street 2:MILE HIGH PRIMARY CARE PC
Practice Address - City:AUROROA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:303-341-4200
Practice Address - Fax:303-341-4480
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP60225Medicare UPIN
466258Medicare ID - Type Unspecified