Provider Demographics
NPI:1013105105
Name:BLAND, LAURA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BLAND
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 1:433 SUMMIT BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8299
Mailing Address - Country:US
Mailing Address - Phone:303-673-9090
Mailing Address - Fax:303-673-9195
Practice Address - Street 1:433 SUMMIT BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8299
Practice Address - Country:US
Practice Address - Phone:303-673-9090
Practice Address - Fax:303-673-9195
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA3950363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000143508Medicaid
CO560830ZYX6Medicare PIN