Healthcare Provider Details

I. General information

NPI: 1730529520
Provider Name (Legal Business Name): LISA MESQEL' PETERSON ACNP, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOYAL MENTAL HEALTH NP

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 NIAGARA RD
MONTROSE CO
81401-5072
US

IV. Provider business mailing address

1677 NIAGARA RD
MONTROSE CO
81401-5072
US

V. Phone/Fax

Practice location:
  • Phone: 970-536-5133
  • Fax: 970-632-6153
Mailing address:
  • Phone: 970-536-5133
  • Fax: 970-632-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0992858
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0992858
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0992858
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: