Individual
MIRANDA E PREJEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1950 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3129
(303) 306-7783
(303) 306-7753
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0003573
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76736776
—
CO
Enumeration date
03/21/2013
Last updated
01/06/2023
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