MEDICARE: MRS. LISA SUE SMITH NP

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	363LA2200X	Adult Health Nurse Practitioner	APN.0004504-NP	CO

General Provider Information

NPI Number	:	1528151941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SUE SMITH NP

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4597
Country	:	US
Telephone Number	:	303-602-3700
Fax Number	:	303-602-3676

Provider Business Practice Location Address
First Line	:	605 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4505
Country	:	US
Telephone Number	:	303-602-3700
Fax Number	:	303-602-3676

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	12/19/2024

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