Provider Demographics
NPI:1982914578
Name:OSTROM, ANDREA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:OSTROM
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 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:303-584-0525
Practice Address - Street 1:850 E HARVARD AVE STE 405
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5077
Practice Address - Country:US
Practice Address - Phone:303-584-8900
Practice Address - Fax:303-584-0525
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO027351OtherKAISER COMMERCIAL NUMBER
CO28087241Medicaid
COP00956729Medicare PIN
CO518733YK5YMedicare PIN
COCOA106111Medicare PIN