Provider Demographics
NPI:1326342338
Name:AMERINE, LISA L (NMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:AMERINE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 COAL CREEK DRIVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:303-665-2423
Mailing Address - Fax:720-302-1622
Practice Address - Street 1:1455 COAL CREEK DRIVE
Practice Address - Street 2:UNIT G
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-665-2423
Practice Address - Fax:720-302-1622
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZND-04830175F00000X
COND.0000048-CO175F00000X
AZ04-830175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath