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NPI Code Detail

MEDICARE: LISA L TENNYSON FNP-BC, PMHNP

MEDICARE: LISA L TENNYSON FNP-BC, PMHNP
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
1363L00000XNurse Practitioner5156WI
2363LF0000XFamily Nurse PractitionerC-APN.0003731-C-NPCO
3363LP0808XPsychiatric/Mental Health Nurse PractitionerC-RXN.0001927-C-NPCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
138220400OTHERWIPROVIDER NUMBER

General Provider Information

NPI Number : 1871562603
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA L TENNYSON FNP-BC, PMHNP
Provider Business Mailing Address
First Line : 4803 BOARDWALK DR STE 120
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3798
Country : US
Telephone Number : 414-324-5278
Fax Number :
Provider Business Practice Location Address
First Line : 4803 BOARDWALK DR STE 120
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3798
Country : US
Telephone Number : 970-310-3406
Fax Number : 888-965-4615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 11/17/2022

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