MEDICARE: MRS. LISA RENEE MCGINNETT

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1649787193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA RENEE MCGINNETT

Provider Business Mailing Address
First Line	:	2686 PATTERSON RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8817
Country	:	US
Telephone Number	:	970-298-6420
Fax Number	:	970-298-6497

Provider Business Practice Location Address
First Line	:	2686 PATTERSON RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8817
Country	:	US
Telephone Number	:	970-298-6420
Fax Number	:	970-298-6497

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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