Individual
LYDIA L. PRUSINOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 S POTOMAC ST, AURORA, CO 80012-5411
(303) 695-2628
(303) 306-7753
Mailing address
PO BOX 173862, DENVER, CO 80217-3862
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004156
CO
363AM0700X
Medical Physician Assistant
5601005910
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27507718
—
CO
Enumeration date
10/20/2010
Last updated
05/11/2015
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