Provider Demographics
NPI:1942671722
Name:HARRIS, LISA LYN (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYN
Other - Last Name:ALDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1832 OPAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOCHBUIE
Mailing Address - State:CO
Mailing Address - Zip Code:80603-7787
Mailing Address - Country:US
Mailing Address - Phone:307-689-4386
Mailing Address - Fax:
Practice Address - Street 1:1832 OPAL AVE
Practice Address - Street 2:
Practice Address - City:LOCHBUIE
Practice Address - State:CO
Practice Address - Zip Code:80603-7787
Practice Address - Country:US
Practice Address - Phone:307-689-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY30762.1445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.1656343OtherSTATE LICENSE
WY30762.1445OtherSTATE LICENSE
COAPN.0993976-NPOtherSTATE LICENSE