Healthcare Provider Details

I. General information

NPI: 1922958990
Provider Name (Legal Business Name): LISA MARIE GRUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 1
COLORADO SPRINGS CO
80907-6794
US

IV. Provider business mailing address

432 W PARKWAY DR
PUEBLO WEST CO
81007-3641
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001932-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: