Provider Demographics
NPI:1407815616
Name:KOLFENBACH, LAUREN LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:KOLFENBACH
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 1:4500 W. 38TH AVE.
Mailing Address - Street 2:STE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2005
Mailing Address - Country:US
Mailing Address - Phone:303-420-1297
Mailing Address - Fax:303-420-2953
Practice Address - Street 1:4500 W. 38TH
Practice Address - Street 2:STE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80112-2005
Practice Address - Country:US
Practice Address - Phone:303-420-1297
Practice Address - Fax:303-420-2953
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50405829Medicaid
CO50405829Medicaid
CO550038Medicare ID - Type UnspecifiedPART B