Provider Demographics
NPI:1609100841
Name:WICK, ANNA-LISA (PSYCHIATRIC NP-BC)
Entity Type:Individual
Prefix:
First Name:ANNA-LISA
Middle Name:
Last Name:WICK
Suffix:
Gender:F
Credentials:PSYCHIATRIC NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173362, CAMPUS BOX 20
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3362
Mailing Address - Country:US
Mailing Address - Phone:303-615-9999
Mailing Address - Fax:
Practice Address - Street 1:955 LAWRENCE WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-615-9999
Practice Address - Fax:303-778-5850
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990095363LP0808X, 163WP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health