Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR DUMC 3322
DURHAM NC
27710-3038
US

IV. Provider business mailing address

2303 S TOWNSEND AVE STE A
MONTROSE CO
81401-5452
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-3786
  • Fax:
Mailing address:
  • Phone: 970-249-7751
  • Fax: 970-249-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0992858
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0992858
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: