Provider Demographics
NPI:1265478465
Name:NEW, LISA G (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:NEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:CO
Mailing Address - Zip Code:80720-1440
Mailing Address - Country:US
Mailing Address - Phone:970-345-6336
Mailing Address - Fax:970-345-5475
Practice Address - Street 1:82 MAIN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-1440
Practice Address - Country:US
Practice Address - Phone:970-345-6336
Practice Address - Fax:970-345-5475
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993778-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425913506Medicaid
500026959OtherRR MEDICARE
KS100426490AMedicaid
OK100846080AMedicaid
MO166360OtherANTHEM
MO425913506Medicaid
KS100426490AMedicaid