Healthcare Provider Details

I. General information

NPI: 1659608479
Provider Name (Legal Business Name): LISA D MCCONNELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

IV. Provider business mailing address

1901 10TH AVE
GREELEY CO
80639-5545
US

V. Phone/Fax

Practice location:
  • Phone: 970-350-5313
  • Fax: 970-346-1166
Mailing address:
  • Phone: 970-515-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0010052
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10052
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: