Provider Demographics
NPI:1922521541
Name:PEREZ, LISA M (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:RIMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:725 S 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:9702407734
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-240-7734
Mailing Address - Fax:970-240-7263
Practice Address - Street 1:725 S 4TH STREET
Practice Address - Street 2:
Practice Address - City:9702407734
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-240-7734
Practice Address - Fax:970-240-7263
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993187-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner