Healthcare Provider Details

I. General information

NPI: 1558691642
Provider Name (Legal Business Name): LISA ELAINE BLAND RN, MSN/MHA, HCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA ELAINE GRAHAM RN

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S PARKER RD
AURORA CO
80014-1622
US

IV. Provider business mailing address

42006 OAKWOOD ST
ELIZABETH CO
80107-9100
US

V. Phone/Fax

Practice location:
  • Phone: 303-636-3006
  • Fax:
Mailing address:
  • Phone: 303-646-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number112250
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: