Healthcare Provider Details

I. General information

NPI: 1336207083
Provider Name (Legal Business Name): LISA MERCK APN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 6TH ST SUITE 202
CRESTED BUTTE CO
81224
US

IV. Provider business mailing address

PO BOX 1273
CRESTED BUTTE CO
81224-1273
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-0100
  • Fax: 647-714-8238
Mailing address:
  • Phone: 970-349-0100
  • Fax: 647-714-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN123427
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: