Healthcare Provider Details

I. General information

NPI: 1013324268
Provider Name (Legal Business Name): METAMORPHOSIS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LATIGO LANE SUITE D
CANON CITY CO
81212-8115
US

IV. Provider business mailing address

PO BOX 1868
CANON CITY CO
81215-1868
US

V. Phone/Fax

Practice location:
  • Phone: 719-371-0000
  • Fax:
Mailing address:
  • Phone: 719-371-0000
  • Fax: 888-965-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.0193071
License Number StateCO

VIII. Authorized Official

Name: MS. LISA GAIL PEARSON
Title or Position: OWNER
Credential: DNAP/CRNA
Phone: 719-371-0000