Provider Demographics
NPI: | 1164906194 |
---|---|
Name: | RICH, LISA M (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | LISA |
Middle Name: | M |
Last Name: | RICH |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 788 W EL PORTAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PUEBLO WEST |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81007-1966 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-545-7016 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 201 CEDAR ST SE STE 405 |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87106-4924 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-984-2560 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-09-15 |
Last Update Date: | 2024-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | C-APN.0001223-C-CNM | 176B00000X |
CO | C-APN.0001224-C-NP | 363LW0102X |
NM | 78397 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 176B00000X | Other Service Providers | Midwife | |
No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |