Provider Demographics
NPI:1770656100
Name:KANTOR, LISA (RN, MN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:RN, MN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 W FREMONT CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-2508
Mailing Address - Country:US
Mailing Address - Phone:303-948-9600
Mailing Address - Fax:
Practice Address - Street 1:5751 BALSAM ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2332
Practice Address - Country:US
Practice Address - Phone:303-423-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84845363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics