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General NPI Number Information
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NPI Number | 1396990164
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Entity Type | Individual
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Provider Name | LISA LALLIER BLACKWELDER FNP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 7610 N UNION BLVD STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3894
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Country | US
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Telephone | 719-550-1172
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Fax | 719-591-2864
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Provider Business Mailing Address
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Address Line | 7610 N UNION BLVD STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3894
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Country | US
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Telephone | 719-550-1172
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Fax | 719-591-2864
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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 | 579092
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2022011328
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0992320-NP
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License Number State | CO
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