Healthcare Provider Details

I. General information

NPI: 1164906194
Provider Name (Legal Business Name): LISA M RICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 405
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

788 W EL PORTAL DR
PUEBLO WEST CO
81007-1966
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-2560
  • Fax:
Mailing address:
  • Phone: 910-545-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberC-APN.0001223-C-CNM
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberC-APN.0001224-C-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number78397
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: