Individual
LARA M ANTONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1107 S LEMAY AVE STE 200, FORT COLLINS, CO 80524-3959
(970) 484-1757
(970) 484-9924
Mailing address
1107 S LEMAY AVE STE 200, FORT COLLINS, CO 80524-3959
(970) 484-1757
(970) 484-9924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 1669
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55828876
—
CO
01
—
848020573009
ROCKY MTN HMO
CO
01
—
AN660037
BCBS
CO
Enumeration date
12/22/2006
Last updated
02/28/2022
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