Provider Demographics
NPI:1154301802
Name:LUDLOW, LAURA A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:LUDLOW
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 1:274 UNION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1836
Mailing Address - Country:US
Mailing Address - Phone:303-951-0600
Mailing Address - Fax:720-302-2617
Practice Address - Street 1:274 UNION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1836
Practice Address - Country:US
Practice Address - Phone:303-951-0600
Practice Address - Fax:720-302-2617
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004963363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP68886Medicare UPIN
KS042935Medicare ID - Type Unspecified