Provider Demographics
NPI:1316424435
Name:PRUMMER, AEDINE (PA)
Entity type:Individual
Prefix:
First Name:AEDINE
Middle Name:
Last Name:PRUMMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AEDINE
Other - Middle Name:
Other - Last Name:PEYOU NDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 S FRASER ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4536
Mailing Address - Country:US
Mailing Address - Phone:303-341-4200
Mailing Address - Fax:
Practice Address - Street 1:2230 S FRASER ST UNIT 1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4536
Practice Address - Country:US
Practice Address - Phone:303-341-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant