Provider Demographics
NPI:1487201034
Name:LUJAN, CARRIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S COLORADO BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3351
Mailing Address - Country:US
Mailing Address - Phone:303-223-6326
Mailing Address - Fax:
Practice Address - Street 1:1001 CECELIA DR STE 200
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2500
Practice Address - Country:US
Practice Address - Phone:262-260-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9486363LP0808X
CO0995162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health