MEDICARE: MRS. LISA ARDATH CASTRO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	31391	TN
2	363L00000X	Nurse Practitioner	905746	MS
3	363L00000X	Nurse Practitioner	0105328	CO

General Provider Information

NPI Number	:	1245542323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ARDATH CASTRO ARNP

Provider Business Mailing Address
First Line	:	7251 W 20TH ST UNIT K
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80634-4626
Country	:	US
Telephone Number	:	970-378-1414
Fax Number	:	970-378-1515

Provider Business Practice Location Address
First Line	:	7251 W 20TH ST UNIT K
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80634-4626
Country	:	US
Telephone Number	:	970-378-1414
Fax Number	:	970-378-1515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	01/21/2026

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