Provider Demographics
NPI:1023412608
Name:VOGLER, LAURA C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:VOGLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SCHALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OA-C
Mailing Address - Street 1:12250 E ILIFF AVE
Mailing Address - Street 2:#300
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6318
Mailing Address - Country:US
Mailing Address - Phone:303-306-4321
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:1451 RIVER PARK DR STE 260
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4504
Practice Address - Country:US
Practice Address - Phone:657-400-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21586870Medicaid
CO21586870Medicaid