Provider Demographics
NPI:1558691642
Name:BLAND, LISA ELAINE (RN, MSN/MHA, HCI)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:BLAND
Suffix:
Gender:F
Credentials:RN, MSN/MHA, HCI
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELAINE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:42006 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-9100
Mailing Address - Country:US
Mailing Address - Phone:303-646-2864
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-636-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112250163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator