Healthcare Provider Details

I. General information

NPI: 1588452668
Provider Name (Legal Business Name): LISA MARIE GUNSHORE AWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 S HAVANA ST # OFFICE
CENTENNIAL CO
80112-3891
US

IV. Provider business mailing address

10784 HILLSBORO ST
PARKER CO
80134-3793
US

V. Phone/Fax

Practice location:
  • Phone: 303-960-8987
  • Fax:
Mailing address:
  • Phone: 303-960-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: