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General NPI Number Information
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NPI Number | 1912642588
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Entity Type | Organization
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Legal Business Name | MONTROSE PSYCHIATRIC NURSE PRACTITIONERS
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 5 HILLCREST PLAZA WAY
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City | MONTROSE
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State | CO
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Zip | 81401-5876
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Country | US
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Telephone | 970-964-8653
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Fax | 970-249-8495
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Provider Business Mailing Address
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Address Line | 5 HILLCREST PLAZA WAY
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City | MONTROSE
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State | CO
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Zip | 81401-5876
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Country | US
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Telephone | 970-964-8653
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Fax | 970-249-8495
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | DR. LISA ANNE BOFFA
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Credential | PMHNP, FNP, ND
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Telephone | 970-964-8653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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