Healthcare Provider Details

I. General information

NPI: 1922521541
Provider Name (Legal Business Name): LISA M PEREZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RIMEL APN

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S 4TH STREET
9702407734 CO
81401
US

IV. Provider business mailing address

725 S 4TH STREET
9702407734 CO
81401
US

V. Phone/Fax

Practice location:
  • Phone: 970-240-7734
  • Fax: 970-240-7263
Mailing address:
  • Phone: 970-240-7734
  • Fax: 970-240-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0993187-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: