Provider Demographics
NPI:1699420919
Name:ROSSO, LAUREN (PA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:ROSSO
Suffix:
Gender:
Credentials:PA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3083
Mailing Address - Fax:303-440-3100
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3586
Practice Address - Country:US
Practice Address - Phone:303-440-3083
Practice Address - Fax:303-440-3100
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant