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General NPI Number Information
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NPI Number | 1932790698
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Entity Type | Individual
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Provider Name | ALECIA LYNETTE DILISA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 720 ELKTON DR # 175
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3516
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Country | US
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Telephone | 719-400-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 215 WILCOX ST APT 2323
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City | CASTLE ROCK
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State | CO
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Zip | 80104-2563
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Country | US
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Telephone | 405-990-9468
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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-RXN.0001215-C-NP
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License Number State | CO
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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 | -APN.0002609-C-NP
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License Number State | CO
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