MEDICARE: LISA MESQEL' PETERSON ACNP, FNP

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	363LA2100X	Acute Care Nurse Practitioner	0992858	CO
2	363L00000X	Nurse Practitioner	0992858	CO

General Provider Information

NPI Number	:	1730529520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MESQEL' PETERSON ACNP, FNP

Provider Business Mailing Address
First Line	:	2303 S TOWNSEND AVE STE A
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-5452
Country	:	US
Telephone Number	:	970-249-7751
Fax Number	:	970-249-5029

Provider Business Practice Location Address
First Line	:	307 TRENT DR
Second Line	:	DUMC 3322
City	:	DURHAM
State	:	NC
Zip	:	27710-3038
Country	:	US
Telephone Number	:	919-684-3786
Fax Number	:

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	11/25/2024

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