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General NPI Number Information
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NPI Number | 1336804277
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Entity Type | Individual
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Provider Name | LISA DIANE ROBERTS NP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 85 REVETT DR
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8956
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Country | US
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Telephone | 239-258-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 85 REVETT DR
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0003225-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10008992
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License Number State | OR
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