Healthcare Provider Details

I. General information

NPI: 1912642588
Provider Name (Legal Business Name): MONTROSE PSYCHIATRIC NURSE PRACTITIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HILLCREST PLAZA WAY
MONTROSE CO
81401-5876
US

IV. Provider business mailing address

5 HILLCREST PLAZA WAY
MONTROSE CO
81401-5876
US

V. Phone/Fax

Practice location:
  • Phone: 970-964-8653
  • Fax: 970-249-8495
Mailing address:
  • Phone: 970-964-8653
  • Fax: 970-249-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA ANNE BOFFA
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP, FNP, ND
Phone: 970-964-8653