Provider Demographics
NPI:1689767154
Name:PRINCE, LISA KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAREN
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RAMPART WAY STE 300B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6451
Mailing Address - Country:US
Mailing Address - Phone:303-327-4711
Mailing Address - Fax:301-295-6081
Practice Address - Street 1:130 RAMPART WAY STE 300B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6451
Practice Address - Country:US
Practice Address - Phone:303-327-4700
Practice Address - Fax:303-327-4711
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101239754207R00000X
CO61378207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine